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Risk factors for long-term, unfavorable prediction in patients after coronary bypass

Altarev S. S., Podaneva Yu. E., Malyshenko E. S., Ivanov S. V., Barbarash O. L.
Federal State Budgetary Institution, "Research Institute for Complex Issues of Cardiovascular Diseases" at the Siberian Branch of the Russian Academy of Medical Sciences, Sosnovy Bulvar 6, Kemerovo 650002

Keywords: CAD, coronary bypass surgery, prognosis, risk factors

DOI: 10.18087/rhj.2015.5.2098

Background. Modeling of short- and long-term risk after cardiac surgical interventions is widely used. However, due to differences in study design and inclusion / exclusion criteria, not all models can be universally applied to populations different from those that have been used for validation of these models. Aim. To determine preoperative, clinical and demographic characteristics of patients associated with development of remote unfavorable outcomes of coronary bypass (CB). Materials and methods. We analyzed data of the Coronary Bypass Registry, which contains information about all CB surgeries performed at the Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, in 2009. Remote results of CB were evaluated in 723 patients. Median follow-up duration was 1639 days; upper and lower quartiles were 1419 and 1866 days, respectively. Endpoint was the composite incidence of cardiovascular death, MI, and unstable angina. Results. For five years of follow-up, the endpoint events were observed in 103 (14.2 %) cases, including 24 (3.3 %) cases of cardiovascular death, 24 (3.3 %) cases of MI, and 60 (8.3 %) hospitalizations for unstable angina. Cox regression analysis showed that the index surgery fort ACS (hazard ratio (HR), 2.83), LV plasty during the index intervention (HR, 2.42), residual period of acute cerebrovascular disease at the time of index surgery (HR, 1.88), and chronic kidney disease (CKD) (HR, 1.52) had the most influence on remote CB outcomes. ROC statistics for the obtained model provided a value of 0.65 (p<0.001). Conclusion. Remote prediction for patients after CB depends on the reason for the index procedure (CB for ACS almost threefold increases the risk of endpoint events) and features of the surgical intervention (LV plasty is associated with higher risk for unfavorable prognosis). In addition, presence of cerebrovascular disease and CKD influence the risk of unfavorable events.
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Altarev S. S., Podaneva Yu. E., Malyshenko E. S., Ivanov S. V., Barbarash O. L. Risk factors for long-term, unfavorable prediction in patients after coronary bypass. Russian Heart Journal. 2015;14 (5):263–272

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