PMID- 28612915
OWN - NLM
STAT- MEDLINE
DCOM- 20180130
LR  - 20180130
IS  - 1897-4279 (Electronic)
IS  - 0022-9032 (Linking)
VI  - 75
IP  - 10
DP  - 2017
TI  - How to predict the risk of postoperative complications after coronary artery 
      bypass grafting in patients under 50 and over 80 years old. A retrospective 
      cross-sectional study.
PG  - 975-982
LID - 10.5603/KP.a2017.0120 [doi]
AB  - BACKGROUND: Coronary artery disease (CAD) remains the leading cause of death in 
      developed countries, and there is an increasing number of both young and elderly 
      patients requiring surgical treatment. Despite improvement of conventional risk 
      stratification scores (EuroSCORE II, STS risk score), all of the calculations are 
      estimated based on the typical population and the studies emphasise that the 
      scales may need further investigation and modernisation because demographic 
      changes of the population suffering from CAD are unavoidable. AIM: To 
      characterise two increasing and challenging cohorts of patients undergoing 
      coronary artery bypass grafting (CABG) and to identify preoperative risk factors 
      for postoperative complications. METHODS: In the retrospective cross-sectional 
      study, we analysed 388 patients >/= 80 years old and 190 patients </= 50 years old, 
      who underwent CABG consecutively at our Institution. Data were obtained from 
      medical records. RESULTS: The vast majority of studied patients had commonly 
      described risk factors for cardiovascular diseases, regardless of the age group. 
      Diabetes was present in almost twice as many individuals in the older cohort, 
      when compared to the EuroSCORE population. A similar observation was made for 
      hypertension, which was more frequent in both age groups. Summarising all of the 
      postoperative complications, at least one occurred significantly more frequently 
      among the older group (10% vs. 20.9%, p = 0.001). The vast majority of major 
      adverse cardiac and cerebrovascular events (MACCE) in the older group led to 
      death (79.4%). Among patients >/= 80 years old, higher New York Heart Association 
      (NYHA) class (p = 0.001, OR 2.05 [1.34-3.12] for every next class) and renal 
      failure (p = 0.02, OR 2.47 [1.16-5.25]) increased the MACCE rate, whereas higher 
      left ven-tricular ejection fraction (LVEF) (p = 0.002, OR 0.81 [0.7-0.93] for 
      every 5%) decreased the risk. Emergent admission was the only factor increasing 
      the occurrence of any postoperative complications among patients </= 50 years old 
      (p = 0.007, OR 3.63, 95% CI 1.37-9.62). On the other hand, among patients >/= 80 
      years old, emergent admission was not associated with any postoperative 
      complications. CONCLUSIONS: Young and old patients requiring CABG differ from the 
      standard EuroSCORE population. Postoperative complications are more common among 
      older patients, and MACCE is usually fatal in this age group. Individuals with 
      risk factors for MACCE (higher NYHA class, renal failure, lower LVEF) should be 
      carefully evaluated and qualified, and closely monitored post-surgery.
FAU - Piatek, Jacek
AU  - Piatek J
FAU - Kedziora, Anna
AU  - Kedziora A
AD  - Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; 
      Department of Cardiovascular Surgery and Transplantology, Jagiellonian 
      University, John Paul II Hospital, Krakow, Poland, Poland. 
      anna.kedziora.mail@gmail.com.
FAU - Kielbasa, Grzegorz
AU  - Kielbasa G
FAU - Olszewska, Marta
AU  - Olszewska M
FAU - Sobczyk, Dorota
AU  - Sobczyk D
FAU - Song, Bryan HyoChan
AU  - Song BH
FAU - Konstanty-Kalandyk, Janusz
AU  - Konstanty-Kalandyk J
FAU - Darocha, Tomasz
AU  - Darocha T
FAU - Wierzbicki, Karol
AU  - Wierzbicki K
FAU - Milaniak, Irena
AU  - Milaniak I
FAU - Wrobel, Krzysztof
AU  - Wrobel K
FAU - Kapelak, Boguslaw
AU  - Kapelak B
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20170614
PL  - Poland
TA  - Kardiol Pol
JT  - Kardiologia polska
JID - 0376352
SB  - IM
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Coronary Artery Bypass/*adverse effects
MH  - Coronary Artery Disease/*surgery
MH  - Cross-Sectional Studies
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/*diagnosis/epidemiology/etiology
MH  - Prognosis
MH  - Retrospective Studies
MH  - Risk Factors
OTO - NOTNLM
OT  - coronary artery bypass grafting
OT  - coronary artery disease
OT  - major adverse cardiac and cerebrovascular events
OT  - postoperative complications
OT  - risk stratification
EDAT- 2017/06/15 06:00
MHDA- 2018/01/31 06:00
CRDT- 2017/06/15 06:00
PHST- 2017/01/06 00:00 [received]
PHST- 2017/05/25 00:00 [accepted]
PHST- 2017/03/12 00:00 [revised]
PHST- 2017/06/15 06:00 [pubmed]
PHST- 2018/01/31 06:00 [medline]
PHST- 2017/06/15 06:00 [entrez]
AID - VM/OJS/KP/11134 [pii]
AID - 10.5603/KP.a2017.0120 [doi]
PST - ppublish
SO  - Kardiol Pol. 2017;75(10):975-982. doi: 10.5603/KP.a2017.0120. Epub 2017 Jun 14.