Risk factors analysis for hospital mortality after emergency coronary artery bypass grafting in patients with acute myocardial infarction_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DENG Hongbo ^1,2 , ZHU Wenjie ² , LI Lei ¹ , DENG Hao ¹ , SHENG Wei ¹ , CHEN Yihan ³ ,  CHI Yifan ⁴ ,  HUA Zhengdong ²

1. Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, 266071, Shandong, P. R. China;
2. Heart Center, Wuhan Asia General Hospital, Wuhan, 430000, P. R. China;
3. Department of Anesthesia Surgery, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, 266071, Shandong,P. R. China;
4. Department of Cardiovascular Surgery, Hiser Medical Center, Medical College of Qingdao University, Qingdao, 266071, Shandong, P. R. China;

Corresponding author：

CHI Yifan, Email: chiyifan@hotmail.com; HUA Zhengdong, Email: charles.hua@163.com

Keywords：

Emergency; acute myocardial infarction; coronary artery bypass grafting; hospital mortality; risk factor

DOI：

10.7507/1007-4848.202012017

Video：

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Objective To identify the risk factors for hospital mortality in patients with acute myocardial infarction (AMI) after emergency coronary artery bypass grafting (CABG).Methods We retrospectively analyzed the clinical data of 145 AMI patients undergoing emergency CABG surgery in Qingdao Municipal Hospital from 2009 to 2019. There were 108 (74.5%) males and 37 (25.5%) females with a mean age of 67.7±11.5 years. According to whether there was in-hospital death after surgery, the patients were divided into a survival group (132 patients) and a death group (13 patients). Preoperative and operative data were analyzed by univariate analysis, followed by multivariate logistic regression analysis, to identify the risk factors for hospital mortality.Results Over all, 13 patients died in the hospital after operation, with a mortality rate of 9.0%. In univariate analysis, significant risk factors for hospital mortality were age≥70 years, recent myocardial infarction, left ventricular ejection fraction (LVEF)<30%, left main stenosis/dissection, operation time and simultaneous surgeries (P<0.05). Multivariate logistic regression analysis showed that LVEF<30% (OR=2.235, 95%CI 1.024-9.411, P=0.014), recent myocardial infarction (OR=4.027, 95%CI 1.934-14.268, P=0.032), operation time (OR=1.039, 95%CI 1.014-1.064, P=0.002) were independent risk factors for hospital mortality after emergency CABG.Conclusion Emergency CABG in patients with AMI has good benefits, but patients with LVEF<30% and recent myocardial infarction have high in-hospital mortality, so the operation time should be shortened as much as possible.

Citation： DENG Hongbo, ZHU Wenjie, LI Lei, DENG Hao, SHENG Wei, CHEN Yihan, CHI Yifan, HUA Zhengdong. Risk factors analysis for hospital mortality after emergency coronary artery bypass grafting in patients with acute myocardial infarction. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(8): 1008-1013. doi: 10.7507/1007-4848.202012017 Copy

1.	Kerendi F, Puskas JD, Craver JM, et al. Emergency coronary artery bypass grafting can be performed safely without cardiopulmonary bypass in selected patients. Ann Thorac Surg, 2005, 79(3): 801-806.
2.	Ferrari E, Stalder N, von Segesser LK. On-pump beating heart coronary surgery for high risk patients requiring emergency multiple coronary artery bypass grafting. J Cardiothorac Surg, 2008, 3: 38.
3.	Sezai A, Hata M, Yoshitake I, et al. Results of emergency coronary artery bypass grafting for acute myocardial infarction: Importance of intraoperative and postoperative cardiac medical therapy. Ann Thorac Cardiovasc Surg, 2012, 18(4): 338-346.
4.	Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol, 2018, 72(18): 2231-2264.
5.	Nashef SA, Roques F, Sharples LD, et al. EuroSCORE Ⅱ. Eur J Cardiothorac Surg, 2012, 41(4): 734-744.
6.	Thanavaro J, Taylor J, Vitt L, et al. Predictors and outcomes of postoperative respiratory failure after cardiac surgery. J Eval Clin Pract, 2020, 26(5): 1490-1497.
7.	刘倩倩, 伏蕊, 宋晨曦, 等. 中国急性心肌梗死患者住院期间死亡的危险因素分析. 中国循环杂志, 2020, 35(1): 24-30.
8.	Solodky A, Behar S, Boyko V, et al. The outcome of coronary artery bypass grafting surgery among patients hospitalized with acute coronary syndrome: The Euro heart survey of acute coronary syndrome experience. Cardiology, 2005, 103(1): 44-47.
9.	Caceres M, Weiman DS. Optimal timing of coronary artery bypass grafting in acute myocardial infarction. Ann Thorac Surg, 2013, 95(1): 365-372.
10.	Bottle A, Mozid A, Grocott HP, et al. Preoperative risk factors in 10418 patients with prior myocardial infarction and 5241 patients with prior unstable angina undergoing elective coronary artery bypass graft surgery. Br J Anaesth, 2013, 111(3): 417-423.
11.	Khan AN, Sabbagh S, Ittaman S, et al. Outcome of early revascularization surgery in patients with ST-elevation myocardial infarction. J Interv Cardiol, 2015, 28(1): 14-23.
12.	Biancari F, Onorati F, Rubino AS, et al. Outcome of emergency coronary artery bypass grafting. J Cardiothorac Vasc Anesth, 2015, 29(2): 275-282.
13.	Waseim AM, Zahra A, Hosam FS. Urgent versus elective coronary artery bypass grafting in acute coronary artery syndrome. J Egypt Soc Cardiothorac Surg, 2018, 26(1): 17-23.
14.	Carr JA, Haithcock BE, Paone G, et al. Long-term outcome after coronary artery bypass grafting in patients with severe left ventricular dysfunction. Ann Thorac Surg, 2002, 74(5): 1531-1536.
15.	Soliman Hamad MA, Tan ME, van Straten AH, et al. Long-term results of coronary artery bypass grafting in patients with left ventricular dysfunction. Ann Thorac Surg, 2008, 85(2): 488-493.
16.	Hamad MA, van Straten AH, Schönberger JP, et al. Preoperative ejection fraction as a predictor of survival after coronary artery bypass grafting: Comparison with a matched general population. J Cardiothorac Surg, 2010, 5: 29.
17.	王海峰, 孙保, 伊力亚斯, 等. 体外循环辅助心脏不停跳冠状动脉旁路移植术在低射血分数患者中的应用. 中国心血管病研究, 2014, 12(5): 438-441.
18.	Sezai A, Nakata K, Iida M, et al. Results of low-dose carperitide infusion in high-risk patients undergoing coronary artery bypass grafting. Ann Thorac Surg, 2013, 96(1): 119-126.
19.	Cartier R, Brann S, Dagenais F, et al. Systematic off-pump coronary artery revascularization in multivessel disease: Experience of three hundred cases. J Thorac Cardiovasc Surg, 2000, 119(2): 221-229.
20.	Westman PC, Lipinski MJ, Luger D, et al. Inflammation as a driver of adverse left ventricular remodeling after acute myocardial infarction. J Am Coll Cardiol, 2016, 67(17): 2050-2060.
21.	Bière L, Garcia G, Guillou S, et al. ST2 as a predictor of late ventricular remodeling after myocardial infarction. Int J Cardiol, 2018, 259: 40-42.
22.	Russo AM, Stainback RF, Bailey SR, et al. ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 appropriate use criteria for implantable cardioverter-defibrillators and cardiac resynchronization therapy: A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol, 2013, 61(12): 1318-1368.
23.	Yalta K, Yilmaz MB, Yalta T, et al. Late versus early myocardial remodeling after acute myocardial infarction: A comparative review on mechanistic insights and clinical implications. J Cardiovasc Pharmacol Ther, 2020, 25(1): 15-26.
24.	吴润达, 姚康, 葛均波. 心肌梗死后心室重构的免疫调节治疗进展. 中国分子心脏病学杂志, 2019, 19(1): 2717-2720.
25.	Zhang L, Mandry D, Chen B, et al. Impact of microvascular obstruction on left ventricular local remodeling after reperfused myocardial infarction. J Magn Reson Imaging, 2018, 47(2): 499-510.
26.	Taniguchi FP, Souza AR, Martins AS. Cardiopulmonary bypass time as a risk factor for acute renal failure. Rev Bras Cir Cardiovasc, 2007, 22(2): 201-205.

1. Kerendi F, Puskas JD, Craver JM, et al. Emergency coronary artery bypass grafting can be performed safely without cardiopulmonary bypass in selected patients. Ann Thorac Surg, 2005, 79(3): 801-806.
2. Ferrari E, Stalder N, von Segesser LK. On-pump beating heart coronary surgery for high risk patients requiring emergency multiple coronary artery bypass grafting. J Cardiothorac Surg, 2008, 3: 38.
3. Sezai A, Hata M, Yoshitake I, et al. Results of emergency coronary artery bypass grafting for acute myocardial infarction: Importance of intraoperative and postoperative cardiac medical therapy. Ann Thorac Cardiovasc Surg, 2012, 18(4): 338-346.
4. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol, 2018, 72(18): 2231-2264.
5. Nashef SA, Roques F, Sharples LD, et al. EuroSCORE Ⅱ. Eur J Cardiothorac Surg, 2012, 41(4): 734-744.
6. Thanavaro J, Taylor J, Vitt L, et al. Predictors and outcomes of postoperative respiratory failure after cardiac surgery. J Eval Clin Pract, 2020, 26(5): 1490-1497.
7. 刘倩倩, 伏蕊, 宋晨曦, 等. 中国急性心肌梗死患者住院期间死亡的危险因素分析. 中国循环杂志, 2020, 35(1): 24-30.
8. Solodky A, Behar S, Boyko V, et al. The outcome of coronary artery bypass grafting surgery among patients hospitalized with acute coronary syndrome: The Euro heart survey of acute coronary syndrome experience. Cardiology, 2005, 103(1): 44-47.
9. Caceres M, Weiman DS. Optimal timing of coronary artery bypass grafting in acute myocardial infarction. Ann Thorac Surg, 2013, 95(1): 365-372.
10. Bottle A, Mozid A, Grocott HP, et al. Preoperative risk factors in 10418 patients with prior myocardial infarction and 5241 patients with prior unstable angina undergoing elective coronary artery bypass graft surgery. Br J Anaesth, 2013, 111(3): 417-423.
11. Khan AN, Sabbagh S, Ittaman S, et al. Outcome of early revascularization surgery in patients with ST-elevation myocardial infarction. J Interv Cardiol, 2015, 28(1): 14-23.
12. Biancari F, Onorati F, Rubino AS, et al. Outcome of emergency coronary artery bypass grafting. J Cardiothorac Vasc Anesth, 2015, 29(2): 275-282.
13. Waseim AM, Zahra A, Hosam FS. Urgent versus elective coronary artery bypass grafting in acute coronary artery syndrome. J Egypt Soc Cardiothorac Surg, 2018, 26(1): 17-23.
14. Carr JA, Haithcock BE, Paone G, et al. Long-term outcome after coronary artery bypass grafting in patients with severe left ventricular dysfunction. Ann Thorac Surg, 2002, 74(5): 1531-1536.
15. Soliman Hamad MA, Tan ME, van Straten AH, et al. Long-term results of coronary artery bypass grafting in patients with left ventricular dysfunction. Ann Thorac Surg, 2008, 85(2): 488-493.
16. Hamad MA, van Straten AH, Schönberger JP, et al. Preoperative ejection fraction as a predictor of survival after coronary artery bypass grafting: Comparison with a matched general population. J Cardiothorac Surg, 2010, 5: 29.
17. 王海峰, 孙保, 伊力亚斯, 等. 体外循环辅助心脏不停跳冠状动脉旁路移植术在低射血分数患者中的应用. 中国心血管病研究, 2014, 12(5): 438-441.
18. Sezai A, Nakata K, Iida M, et al. Results of low-dose carperitide infusion in high-risk patients undergoing coronary artery bypass grafting. Ann Thorac Surg, 2013, 96(1): 119-126.
19. Cartier R, Brann S, Dagenais F, et al. Systematic off-pump coronary artery revascularization in multivessel disease: Experience of three hundred cases. J Thorac Cardiovasc Surg, 2000, 119(2): 221-229.
20. Westman PC, Lipinski MJ, Luger D, et al. Inflammation as a driver of adverse left ventricular remodeling after acute myocardial infarction. J Am Coll Cardiol, 2016, 67(17): 2050-2060.
21. Bière L, Garcia G, Guillou S, et al. ST2 as a predictor of late ventricular remodeling after myocardial infarction. Int J Cardiol, 2018, 259: 40-42.
22. Russo AM, Stainback RF, Bailey SR, et al. ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 appropriate use criteria for implantable cardioverter-defibrillators and cardiac resynchronization therapy: A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol, 2013, 61(12): 1318-1368.
23. Yalta K, Yilmaz MB, Yalta T, et al. Late versus early myocardial remodeling after acute myocardial infarction: A comparative review on mechanistic insights and clinical implications. J Cardiovasc Pharmacol Ther, 2020, 25(1): 15-26.
24. 吴润达, 姚康, 葛均波. 心肌梗死后心室重构的免疫调节治疗进展. 中国分子心脏病学杂志, 2019, 19(1): 2717-2720.
25. Zhang L, Mandry D, Chen B, et al. Impact of microvascular obstruction on left ventricular local remodeling after reperfused myocardial infarction. J Magn Reson Imaging, 2018, 47(2): 499-510.
26. Taniguchi FP, Souza AR, Martins AS. Cardiopulmonary bypass time as a risk factor for acute renal failure. Rev Bras Cir Cardiovasc, 2007, 22(2): 201-205.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors analysis for hospital mortality after emergency coronary artery bypass grafting in patients with acute myocardial infarction

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