Detrimental predictive effect of metabolic syndrome on postoperative complications in patients who undergoing coronary artery bypass grafting.

BACKGROUND: The present study came to address the value of metabolic syndrome (MetS) in predicting postoperative outcome following coronary artery bypass grafting (CABG). METHODS: In a retrospective study, a consecutive series of patients including 2010 subjects who underwent isolated CABG were reviewed. Baseline information and intraoperative details were collected by reviewing hospital-recorded files. The composite outcome of major adverse cardiac and cerebrovascular events (postoperative morbidity) was generated from the occurrence of myocardial infarction, cardiac arrhythmias, stroke, renal failure, and other cardiac-related problems. RESULTS: Overall, 2010 patients who underwent isolated CABG were studied that among them 24.7% suffered from MetS. No difference was found in the prevalence of postoperative arrhythmias, brain stroke, multi-organ failure, and dialysis between the two groups with and without MetS. Early morbidity rate was 27.4% in MetS group and 27.8% in non-MetS group with no significant discrepancy. Using multivariable logistic regression modeling, we showed that MetS status could not predict postoperative morbidity; however, advanced age, history of congestive heart failure, higher Canadian Cardiovascular Society (CCS) scale, and longer cross-clamp time were main indicators of postoperative morbidity.  CONCLUSION: MetS has no detrimental predictive effect on early postoperative morbidity in CABG patients. (www.actabiomedica.it).

Influence of the timing of cardiac catheterization and amount of contrast media on acute renal failure after cardiac surgery.

BACKGROUND: There is limited data about the influence of timing of cardiac surgery in relation to diagnostic angiography and/or the impact of the amount of contrast media used during angiography on the occurance of acute renal failure (ARF). Therefore, in the present study the effect of the time interval between diagnostic angiography and cardiac surgery and also the amount of contrast media used during the diagnostic procedure on the incidence of ARF after cardiac surgery was investigated. METHODS: Data of 1177 patients who underwent different types of cardiac surgeries after cardiac catheterization were prospectively examined. The influence of time interval between cardiac catheterization and surgery as well as the amount of contrast agent on postoperative ARF were assessed using multivariable logistic regression. RESULTS: The patients who progressed to ARF were more likely to have received a higher dose of contrast agent compared to the mean dose. However, the time interval between cardiac surgery and last catheterization was not significantly different between the patients with and without ARF (p = 0.05). Overall, postoperative peak creatinine was highest on day 0, then decreased and remained significantly unchanged after this period. Overall prevalence of acute renal failure during follow-up period had a changeable trend and had the highest rates in days 1 (53.57%) and 6 (52.17%) after surgery. Combined coronary bypass and valve surgery were the strongest predictor of postoperative ARF (OR: 4.976, CI = 1.613-15.355 and p = 0.002), followed by intra-aortic balloon pump insertion (OR: 6.890, CI = 1.482-32.032 and p = 0.009) and usage of higher doses of contrast media agent (OR: 1.446, CI = 1.033-2.025 and p = 0.031). CONCLUSIONS: Minimizing the amount of contrast agent has a potential role in reducing the incidence of postoperative ARF in patients undergoing cardiac surgery, but delaying cardiac surgery after exposure to these agents might not have this protective effect.

Evaluation of accuracy of Euroscore risk model in prediction of perioperative mortality after coronary bypass graft surgery in Isfahan.

BACKGROUND: This study aimed to evaluate the accuracy of Euroscore (European System for Cardiac Operative Risk Evaluation) in predicting perioperative mortality after cardiac surgery in Iranian patient population. METHODS: Data on 1362 patients undergoing coronary bypass graft surgery (CABG) from 2007 to 2009 were collected. Calibration was assessed by Hosmer-Lemeshow goodness-of-fit. Area under the curve (AUC) was used to assess score validity. Odds ratios were measured to evaluate the predictive value of each risk factor on mortality rate. RESULTS: The overall perioperative in hospital mortality was 3.6% whereas the Euroscore predicted a mortality of 3.96%. Euroscore model fitted well in the validation databases. The mean AUC was 66%. Mean length of intensive care unit (ICU) stay was 2.5 ± 2.5 days. Among risk factors, only left ventricular dysfunction, age and neurologic dysfunction were found to be related to mortality rate. CONCLUSIONS: Euroscore did not have acceptable discriminatory ability in perioperative in hospital mortality in Iranian patients. It seems that development of a local mortality risk scores corresponding to our patients epidemiologic characteristics may improve prediction of outcome.