Determination of comorbidity index for high-risk patients with coronary artery disease before cardiac surgery
Keywords:coronary artery disease, high-risk patient, comorbidity, cardiac surgery
The aim: to determine the comorbidity index before cardiac surgery in high-risk patients with coronary artery disease (CAD).
Materials and methods. A retrospective analysis of data from 354 random high-risk patients who underwent a surgery and were discharged from National M. Amosov Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine during the period 2009–2019. The mean age of patients was 61.9 ± 9.6 years. All the patients were examined: ECG, ECHO CG, coronary angiography before the surgery as well as Charlson comorbidity index was calculated and a risk on the scales EuroSCORE I, EuroSCORE II and STS was stratified.
Results. I–III degree obesity was revealed in 133 (37.5 %) patients, patients with type 2 diabetes mellitus (DM) were more likely to have BMI >30 kg/m2 (P = 0.017). Patients with normal weight had a carotid artery stenosis >50 % (P = 0.014) and history of stroke (P = 0.043) significantly more frequently. No differences in comorbidity of overweight and normal weight patients were detected (5.73 ± 1.70 vs. 5.9 ± 1.8, P = 0.4638). Type 2 DM was diagnosed in 90 (25.4 %) patients. In the case of normoglycemia, the comorbidity index was significantly lower than in type 2 DM (4.88 ± 1.38 vs. 6.60 ± 2.03, P = 0.0001) and glucose intolerance 5.8 ± 1.5 (P < 0.0001). Chronic kidney disease (CKD) G3a–G4 stages was diagnosed in 132 (37.2 %) patients. Significant higher comorbidity was found in patients with G3a–G4 stages CKD in comparison to those with G1–G2 stages CKD – 6.33 ± 1.78 vs. 5.46 ± 1.60 (P < 0.0001). Among comorbidities in patients with gouty arthritis, type 2 DM (P < 0.0001), obesity (P = 0.0080), CKD G3a–G4 (P = 0.0020) and varicose veins of the lower extremities (P = 0.0214) were significantly more common. Preoperative risk stratification according to the EuroSCORE II scale averaged 8.8 %.
Conclusions. Preoperative analysis of baseline status in CAD patients showed the high Charlson comorbidity index, which averaged 5.7 ± 1.7. The weak direct correlation between the comorbidity index and the high predicted cardiac risk on the ES II scale (r = 0.2356, P = 0.00001), length of stay in the intensive care unit (r = 0.1182, P = 0.0262) and discharge after the surgery (r = 0.1134, P = 0.0330) was found.
Shehata, I. M., Odell, T. D., Elhassan, A., Spektor, M., Urits, I., Viswanath, O., Jeha, G. M., Cornett, E. M., & Kaye, A. D. (2021). Preoperative, Multidisciplinary Clinical Optimization of Patients with Severely Depressed Left Ventricular Ejection Fraction Who Are Undergoing Coronary Artery Bypass Grafting. Cardiology and Therapy, 10(1), 57-66. https://doi.org/10.1007/s40119-020-00207-1
Oreel, T. H., Nieuwkerk, P. T., Hartog, I. D., Netjes, J. E., Vonk, A., Lemkes, J., van Laarhoven, H., Scherer-Rath, M., Sprangers, M., & Henriques, J. (2020). Gender differences in quality of life in coronary artery disease patients with comorbidities undergoing coronary revascularization. PLOS ONE, 15(6), Article e0234543. https://doi.org/10.1371/journal.pone.0234543
Lamy, A., Devereaux, P. J., Prabhakaran, D., Taggart, D. P., Hu, S., Straka, Z., Piegas, L. S., Avezum, A., Akar, A. R., Lanas Zanetti, F., Jain, A. R., Noiseux, N., Padmanabhan, C., Bahamondes, J. C., Novick, R. J., Tao, L., Olavegogeascoechea, P. A., Airan, B., Sulling, T. A., Whitlock, R. P., … CORONARY Investigators. (2016). Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting. The New England Journal of Medicine, 375(24), 2359-2368. https://doi.org/10.1056/NEJMoa1601564
Shroyer, A. L., Grover, F. L., Hattler, B., Collins, J. F., McDonald, G. O., Kozora, E., Lucke, J. C., Baltz, J. H., Novitzky, D., & Veterans Affairs Randomized On/Off Bypass (ROOBY) Study Group. (2009). On-pump versus off-pump coronary-artery bypass surgery. The New England Journal of Medicine, 361(19), 1827-1837. https://doi.org/10.1056/NEJMoa0902905
Rogers, C. A., Pike, K., Campbell, H., Reeves, B. C., Angelini, G. D., Gray, A., Altman, D. G., Miller, H., Wells, S., Taggart, D. P., & CRISP investigators. (2014). Coronary artery bypass grafting in high-RISk patients randomised to off- or on-Pump surgery: a randomised controlled trial (the CRISP trial). Health Technology Assessment, 18(44). https://doi.org/10.3310/hta18440
Neumann, F. J., Sousa-Uva, M., Ahlsson, A., Alfonso, F., Banning, A. P., Benedetto, U., Byrne, R. A., Collet, J. P., Falk, V., Head, S. J., Jüni, P., Kastrati, A., Koller, A., Kristensen, S. D., Niebauer, J., Richter, D. J., Seferović, P. M., Sibbing, D., Stefanini, G. G., & Windecker, S. (2018). 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal, 40(2), 87-165. https://doi.org/10.1093/eurheartj/ehy394
Kar, P., Geeta, K., Gopinath, R., & Durga, P. (2017). Mortality prediction in Indian cardiac surgery patients: Validation of European System for Cardiac Operative Risk Evaluation II. Indian Journal of Anaesthesia, 61(2), 157-162. https://doi.org/10.4103/ija.IJA_522_16
De Santo, L. S., Moscariello, C., & Zebele, C. (2018). Implications of obesity in cardiac surgery: pattern of referral, physiopathology, complications, prognosis. Journal of Thoracic Disease, 10(7), 4532-4539. https://doi.org/10.21037/jtd.2018.06.104
Gogayeva, O. (2021). Vplyv zaivoi vahy na perioperatsiinyi perebih u patsiientiv z ishemichnoiu khvoroboiu sertsia vysokoho ryzyku v kardiokhirurhii [The Influence of Obesity on Perioperative Course in High-Risk Patients with Coronary Artery Disease in Cardiac Surgery]. Ukrainian Journal of Cardiovascular Surgery, (1), 20-27. https://doi.org/10.30702/ujcvs/21.4203/g002020-027/24036 [in Ukrainian].
Holzmann, M. J., Rathsman, B., Eliasson, B., Kuhl, J., Svensson, A. M., Nyström, T., & Sartipy, U. (2015). Long-term prognosis in patients with type 1 and 2 diabetes mellitus after coronary artery bypass grafting. Journal of the American College of Cardiology, 65(16), 1644-1652. https://doi.org/10.1016/j.jacc.2015.02.052
Gogayeva, O., Lazoryshynets, V., Rudenko, A., Dzakhoieva, L., & Yuvchyk, O. (2020). Peryoperatsiina otsinka funktsii nyrok u patsiientiv vysokoho ryzyku z uskladnenymy formamy IKhS [Perioperative evaluation of kidney function for patients with complicated forms of coronary artery disease]. Ukrainian Journal of Nephrology and Dialysis, (4), 52-58. https://doi.org/10.31450/ukrjnd.4(68).2020.08 [in Ukrainian].
Pagidipati, N. J., Clare, R. M., Keenan, R. T., Chiswell, K., Roe, M. T., & Hess, C. N. (2018). Association of Gout With Long-Term Cardiovascular Outcomes Among Patients With Obstructive Coronary Artery Disease. Journal of the American Heart Association, 7(16), Article e009328. https://doi.org/10.1161/JAHA.118.009328
Gogayeva, O., Rudenko, A., & Lazoryshynets, V. (2020). Porivniannia metodyk vintsevoho shuntuvannia na pratsiuiuchomu sertsi ta v umovakh shtuchnoho krovoobihu. Dosvid uchasti v mizhnarodnomu klinichnomu doslidzhenni [Comparison of On-Pump and Off-Pump Coronary Artery Bypass Grafting. Our experience of participation in the international study]. Ukrainian Journal of Cardiovascular Surgery, (4), 9-14. https://doi.org/10.30702/ujcvs/20.4112/048009-014/1.53 [in Ukrainian].
Ursulenko, V. I., Gogayeva, O. K., & Dzakhoieva, L. S. (2017). Okklyuziya podklyuchichnoi arterii kak prichina retsidiva stenokardii posle mammarnogo shuntirovaniya [Occlusion of the left subclavian artery as a reason of angina pectoris recurrence after coronary artery bypass grafting]. Kardiokhirurhiia ta interventsiina kardiolohiia, (3), 48-52. [in Russian].
Klester, E. B., Shoykhet, Y. N., Elykomov, V. A., & Rudakova, D. M. (2019). Co morbidity as a risk factor for CABG patients of elderly and senile age. MOJ Gerontology & Geriatrics, 4(3), 87-88. https://doi.org/10.15406/mojgg.2019.04.00185
How to Cite
LicenseAuthors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)