ANALYSIS OF PREOPERATIVE RISK FACTORS FOR FATAL OUTCOME OF CORONARY ARTERY BYPASS GRAFTING

Highlights

• Preoperative risk factors that affect the fatal outcome of coronary artery bypass grafting performed at the Voronezh Cardiac Surgery Center were identified.
• The IV functional class of angina pectoris, the EuroSCORE II value, the ejection fraction, the fact of unstable angina pectoris in the previous month, and pulmonary hypertension had an impact on the lethal outcome of surgery at a significance level < 0.001.
• The level of statistical significance < 0.05 was influenced by multifocal atherosclerosis, the fact and duration of myocardial infarction, and the functional class of chronic heart failure.

Aim. Analysis of the influence of preoperative risk factors on the fatal outcome of coronary artery bypass grafting.

Methods. The materials for the study were medical documentation data obtained from 1,584 patients who underwent coronary artery bypass grafting in 2021–2024. The analysis was carried out on the basis of 24 preoperative signs and the fact of death in the early postoperative period. Spearman's correlation analysis was used in the statistical processing of the material, and the normality of the distribution of feature values was assessed using the Kolmogorov–Smirnov and CHI² tests.

Results. The IV functional class of angina pectoris, the EuroSCORE II value, the ejection fraction, the fact of unstable angina pectoris in the previous month, and pulmonary hypertension had an impact on the lethal outcome of surgery at a significance level < 0.001. At the level of statistical significance < 0.05, multifocal atherosclerosis, the fact and duration of myocardial infarction, and the functional class of chronic heart failure had an impact on death.

Conclusion. The research work provides information about the patient's risk factors that have the greatest and least impact on the development of death during surgery and in the early postoperative period. Since the correlation analysis did not reveal the prevailing interrelationships of individual signs, a regression analysis should be performed to further predict the fatal outcome.

1. Kharchenko V. V., Ivanov V. A., Vetrov A. O. Coronary heart disease: complications, epidemiology, prevention. Integrative trends in medicine and education. 2022; 3: 149-153 (In Russ)

2. Solovyova D. V., Grigorieva N. Yu., Yarygin V. V. Features of the course of myocardial infarction at a young age. Medical almanac. 2023; 4(77): 110-115(In Russ)

3. Klester E. B., Elykomov V. A., Klester K. V. Analysis of the frequency and nature of concomitant diseases as a risk factor for complications and adverse outcome during coronary artery bypass grafting in elderly and senile patients. Pulse Medical and Pharmaceutical Magazine. 2022; 24(4): 10-15: doi 10.26787/nydha-2686-6838-2022-24-4-10-15

4. Bernhard B, Ge Y, Antiochos P, Heydari B, Islam S, Sanchez Santiuste N, Steel KE, Bingham S, Mikolich JR, Arai AE, Bandettini WP, Patel AR, Shanbhag SM, Farzaneh-Far A, Heitner JF, Shenoy C, Leung SW, Gonzalez JA, Raman SV, Ferrari VA, Shah DJ, Schulz-Menger J, Stuber M, Simonetti OP, Kwong RY. Association of Adverse Clinical Outcomes With Peri-Infarct Ischemia Detected by Stress Cardiac Magnetic Imaging. J Am Coll Cardiol. 2024;84(5):417-429: doi: 10.1016/j.jacc.2024.04.062.

5. Mahmoud SES, Shahin M, Yousif N, Denegri A, Abo Dahab LH, Lüscher TF. Cardiovascular Risk Profile, Presentation and Management Outcomes of Patients with Acute Coronary Syndromes after Coronary Artery Bypass Grafting. Curr Probl Cardiol. 2022; 47(11):101078. doi: 10.1016/j.cpcardiol.2021.101078.

6. Hochman JS, Anthopolos R, Reynolds HR, Bangalore S, Xu Y, O'Brien SM, Mavromichalis S, Chang M, Contreras A, Rosenberg Y, Kirby R, Bhargava B, Senior R, Banfield A, Goodman SG, Lopes RD, Pracoń R, López-Sendón J, Maggioni AP, Newman JD, Berger JS, Sidhu MS, White HD, Troxel AB, Harrington RA, Boden WE, Stone GW, Mark DB, Spertus JA, Maron DJ; ISCHEMIA-EXTEND Research Group. Survival After Invasive or Conservative Management of Stable Coronary Disease. Circulation. 2023;147(1):8-19. doi: 10.1161/CIRCULATIONAHA.122.062714

7. Jung JC, Ju JW, Chang HW, Lee JH, Kim DJ, Lim C, Park KH, Kim JS. Predictive Performances of ACEF, ACEF II, Updated ACEF II, and EuroSCORE II Risk Scores in Patients Undergoing Isolated Off-pump Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth. 2024;38(12):2932-2938: doi: 10.1053/j.jvca.2024.08.011.

8. Baryshnikova G. A., Chorbinskaya S. A., Stepanova I. I. Additional possibilities for optimizing the management of patients with chronic heart failure. Polyclinic. 2024; 3: 15-18

9. Loginova I. Yu., Klinkova A. S., Kamenskaya O. V. The effect of rhythm disturbances on the results of combined pulmonary endarterectomy and coronary bypass surgery in patients with chronic thromboembolic pulmonary hypertension and coronary heart disease. Eurasian Journal of Cardiology. 2024; 4(49): 68-73: doi: 10.38109/2225-1685-2024-4-68-73

10. Kobzeva N. D., Terentyev V. P. Peculiarities of the influence of atherosclerotic lesion of the arteries of the lower extremities on long-term outcomes in patients with multifocal atherosclerosis. Medical science and education of the Urals. – 2022; 3(111): 142-145: doi: 10.36361/18148999_2022_23_3_142.

11. Bernard C, Morgant MC, Jazayeri A, Perrin T, Malapert G, Jazayeri S, Bernard A, Bouchot O. Optimal Timing of Coronary Artery Bypass Grafting in Haemodynamically Stable Patients after Myocardial Infarction. Biomedicines. 2023;11(3):979: doi: 10.3390/biomedicines11030979.

12. Esmaeilzadeh S, Vinzant N, Ramakrishna H. Outcomes in Women Undergoing Coronary Artery Bypass Grafting: Analysis of New Data and Operative Trends. J Cardiothorac Vasc Anesth. 2025;39(2):532-537: doi: 10.1053/j.jvca.2024.10.031.

13. Elbadawi A, Elzeneini M, Elgendy IY, Megaly M, Omer M, Jimenez E, Ghanta RK, Brilakis ES, Jneid H. Coronary artery bypass grafting after acute ST-elevation myocardial infarction. J Thorac Cardiovasc Surg. 2023;165(2):672-683.e10. doi: 10.1016/j.jtcvs.2021.03.081.

14. Lozada-Ramos H, Daza-Arana JE, Zárate González M, Medina Gallo LF, Lanas F. Risk factors for in-hospital mortality after coronary artery bypass grafting in Colombia. J Cardiovasc Surg (Torino). 2022;63(1):78-84. doi: 10.23736/S0021-9509.21.11829-4.

15. Hirnle G, Stankiewicz A, Mitrosz M, Aboul-Hassan SS, Deja M, Rogowski J, Cichoń R, Anisimowicz L, Bugajski P, Tobota Z, Maruszewski B, Hrapkowicz T; KROK Investigators. Gender Differences in Survival after Coronary Artery Bypass Grafting-13-Year Results from KROK Registry. J Clin Med. 2024;13(14):4080. doi: 10.3390/jcm13144080.

16. Jang WJ, Choi KH, Kim J, Yang JH, Hahn JY, Choi SH, Gwon HC, Cho YH, Sung K, Kim WS, Jeong DS, Song YB. Impact of gender on mid-term prognosis of patients undergoing coronary artery bypass grafting. PLoS One. 2023;18(3):e0279030. doi: 10.1371/journal.pone.0279030.