Main predictor of post CABG mortality and morbidity at National Heart Institute

Background CABG significantly increases life expectancy. Complete myocardial revascularization should be the main goal of the surgical intervention. CABG is a widely used therapeutic modality in the treatment of atherosclerotic coronary artery disease. Aim and objectives To describe the clinical characteristics of patients undergoing first time, isolated CABG and relation to its early outcome, in National Heart Institute which is a tertiary center in Egypt. Methods A prospective observational study, single center was conducted in National Heart Institute between November 2018 and January 2021. Result The current prospective observational study included 511 consecutive patients. Regarding the final outcome of the study, mortality was recorded in 26 cases (5.1%) of the cases and MACCE was detected in 65 cases (12.7%) of the total cases. Mortality was significantly higher among diabetics (p value 0.004), uncontrolled DM with higher HbA1C (p<0.001), dyslipidemias (p=0.010), higher NYHA class (p= 0.027), previous stent/PTCA (p<0.001), higher BMI (p<0.001), preoperative creatinine (p=0.028), Also that mortality was significantly higher among cases who underwent endarterectomy, those who needed high support or IABP, post CABG MI and low COP, postoperative stroke and positive MACCE cases. The P value was highly significant (<0.001) for each of these factors. Also, mortality was significantly associated with higher cumulative XC time (p value = 0.041). Using logistic regression analysis, we found that endarterectomy, post CABG MI, postoperative neurological complications and aortic cross clamp time were independent risk factors for mortality among the included cases. MACCE was significantly higher among dyslipidemics, previous PTCA/stent, cases with endarterectomy, patients needing higher postoperative support or IABP, cases with post CABG MI, low COP or re-exploration, cases needing higher units of blood transfusion, postoperative neurological complications and postoperative pulmonary complications, reclosure of the sternum and higher ICU stay. The p value was highly significant (<0.001) for each of these factors. Also, MACCE was significantly higher among patients with older age (p=0.001), higher BMI (p=0.003), lower creatinine clearance (p=0.033), higher HbA1C (p=0.001), recent MI cases (p=0.025), and total hospital stay (p=0.013). Using logistic regression analysis, we found that older age, dyslipidemia, previous PTCA/stent, endarterectomy, low COP, higher number of blood units needed, longer ICU duration and postoperative pulmonary complications were independent risk factors for MACCE among the studied cases. Conclusion Isolated coronary artery bypass surgery is generally performed successfully in the national heart institute with standard technique using warm or cold cardioplegia with acceptable morbidity and mortality rates compared to other international heart centers.