Relationship Between Pre Operation Risk Factor Profiles With Clinical Outcomes In Post Isolated CABG Patients Treated In ICU

Daondy Friarsa Soeharto; Rita Zahara; Bagus Herlambang; Bambang Widyantoro; Sugisman Sugisman

doi:10.30701/ijc.2067

Daondy Friarsa Soeharto, MD Faculty of Medicine, Udayana University, Denpasar, Indonesia
Rita Zahara, MD Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
Bagus Herlambang, MD Department of Thoracic, Cardiac and Vascular Surgery Faculty of Medicine, Universitas Indonesia/ Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
Bambang Widyantoro, MD Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ Harapan Kita National Cardiovascular Center, Jakarta, Indonesia
Sugisman Sugisman, MD Department of Thoracic, Cardiac and Vascular Surgery Faculty of Medicine, Universitas Indonesia/ Harapan Kita National Cardiovascular Center, Jakarta, Indonesia

DOI: https://doi.org/10.30701/ijc.2067

Keywords: Mortality, Prolonged ICU, Isolated-CABG, Risk Factor, Indonesia

Abstract

Background: Atherosclerotic Cardiovascular Disease (ASCVD) causes around 31% death all over the world. This disease can be managed with Coronary Artery Bypass Graft (CABG). Although its success ratio continues to increase, patients tend to have more complex conditions, which complicate the results.

Methods: This retrospective cohort study was conducted with samples consisting of ≥18 years old patients who underwent isolated CABG between January 2017 and June 2022 and were admitted to the Intensive Care Unit (ICU) afterward. Clinical outcomes measured were prolonged ICU and intrahospital mortality. A 77-hour post-procedural ICU treatment period is considered the standard of care.

Result: A total of 2611 patients were included. The mean age was 59 years. Geriatric, overweight, obesity, kidney failure, Heart Failure with reduced Ejection Fraction (HFrEF), Cardiogenic Shock, Left Main Disease (LMD), and Pre Incision Intra-Aortic Balloon Pump (IABP) are associated with prolonged ICU care; while female gender, Family history of ASCVD, Diabetes, Hypertension, Acute Coronary Syndrome (ACS), Stroke, and history of cardiac surgery are associated with higher mortality. The lengthening of ICU care is also associated with higher mortality (OR 4.02; p<0.00). According to multivariate analysis, the factors associated with prolonged ICU are geriatric, obesity, kidney failure, stroke, HFrEF, Cardiogenic shock, very poor Ejection Fraction (EF), urgent procedure and pre incision IABP, meanwhile factors associated with mortality are female, diabetes, stroke, history of ACS<24H, poor and very poor EF, History of Cardiac Surgery, and prolonged ICU itself.

Conclusion: In Indonesian isolated CABG patients, prolonged ICU stay and increased mortality are independently driven by specific demographic, comorbid, and clinical factors, necessitating targeted preoperative risk assessment to optimize outcomes.

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References

1. Sangkot H, Trisnanto P. Mortality and Morbidity in Elective Patient of Coronary Artery Bypass Graph at National Cardiovascular Center, Harapan Kita Hospital, Indonesia. Modern Health Science. 2019;2(2):p32.
2. Rinaldi I, Sudaryo M, Mansjoer A. Pre-operative, Intraoperative, and Post-operative Determinants Associated with 30-day Mortality Post-Coronary Artery Bypass Graft: A Retrospective Cohort Study. Open Access Macedonian Journal of Medical Sciences. 2022;10(B):1022-1028.
3. Widyastuti Y, Stenseth R, Wahba A, Pleym H, Videm V. Length of intensive care unit stay following cardiac surgery: is it impossible to find a universal prediction model?. Interactive CardioVascular and Thoracic Surgery. 2012;15(5):825-832.
4. Hein O, Birnbaum J, Wernecke K, England M, Konertz W, Spies C. Prolonged Intensive Care Unit Stay in Cardiac Surgery: Risk Factors and Long-Term-Survival. The Annals of Thoracic Surgery. 2006;81(3):880-885.
5. Heimrath O, Buth K, Légaré J. Long-term outcomes in patients requiring stay of more than 48 hours in the intensive care unit following coronary bypass surgery. Journal of Critical Care. 2007;22(2):153-158.
6. Kao K, Lee S, Liu C, Chou N. Risk factors associated with longer stays in cardiovascular surgical intensive care unit after CABG. Journal of the Formosan Medical Association. 2022;121(1):304-313.
7. Suwatri W, Hanafy D, Sugisman S. Cardiovascular Outcomes in High-Risk Patients Undergoing OPCAB Surgery Compared to Traditional CABG. 2022.
8. Hassan A, Anderson C, Kypson A, Kindell L, Ferguson T, Chitwood W et al. Clinical Outcomes in Patients With Prolonged Intensive Care Unit Length of Stay After Cardiac Surgical Procedures. The Annals of Thoracic Surgery. 2012;93(2):565-569.
9. Saxena A, Shan L, Reid C, Dinh D, Smith J, Shardey G et al. Impact of smoking status on early and late outcomes after isolated coronary artery bypass graft surgery. 2022.
10. Nashef S, Roques F, Sharples L, Nilsson J, Smith C, Goldstone A et al. EuroSCORE II. European Journal of Cardio-Thoracic Surgery. 2012;41(4):734-745.
11. Herlitz J, Brandrup-Wognsen G, Haglid M, Hartford M, Emanuelsson H, Karlson B et al. Original article 309 Mortality and morbidity during a period of 2 years after coronary artery bypass surgery in patients with and without a history of hypertension. Journal of Hypertension. 1996;14(3):309-314.
12. Gunnarsdóttir E, Gunnarsdóttir S, Heimisdóttir A, Heiðarsdóttir S, Helgadóttir S, Guðbjartsson T et al. Algengi og áhættuþættir lengdrar dvalar á gjörgæsludeild eftir kransæðahjáveituaðgerð. Læknablaðið. 2020;2020(03):123-129.
13. Oliveira E, Turquetto A, Tauil P, Junqueira Junior L, Porto L. Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting. Revista Brasileira de Cirurgia Cardiovascular. 2013;28(3):353-363.
14. Zangrillo A, Pappalardo F, Dossi R, Di Prima A, Sassone M, Greco T et al. Preoperative intra-aortic balloon pump to reduce mortality in coronary artery bypass graft: a meta-analysis of randomized controlled trials. Critical Care. 2015;19(1).