Age influences outcomes in 70-year or older patients undergoing isolated coronary artery bypass graft surgery
Age influences outcomes in 70-year or older patients undergoing isolated coronary artery bypass graft surgery
Data
2012
Autores
Rocha, Antônio Sergio C. da
Pittella, Felipe
De Lorenzo, Andrea
Barzan, Valmir
Colafranceschi, Alexandre Siciliano
Brito, José Oscar R.
Mattos, Marco Antonio de
Silva, Paulo Roberto Dutra da
Journal Title
Journal ISSN
Volume Title
Publisher
Revista Brasileira de Cirurgia Cardiovascular
Resumo
Objetivo: Analisar os resultados da cirurgia de revascularização miocárdica (CRVM) isolada com circulação extracorpórea em pacientes com idade ³ 70 anos em comparação àqueles com < 70 anos. Métodos: Pacientes submetidos consecutivamente à CRVM isolada. Os pacientes foram agrupados em G1 (idade³ 70 anos) e G2 (idade < 70 anos). Os desfechos analisados foram letalidade hospitalar, infarto agudo miocárdio (IAM), acidente vascular encefálico (AVE), reoperação para revisão de hemostasia (RRH), necessidade de balão intra-aórtico (BIA), complicações respiratórias, insuficiência renal aguda (IRA), mediastinite, sepse, fibrilação atrial (FA) e bloqueio atrioventricular total (BAVT). Resultados: Foram estudados 1033 pacientes, 257 (24,8%) do G1 e 776 (75,2%) do G2. A letalidade hospitalar foi significantemente maior no G1 quando comparado ao G2 (8,9% vs. 3,6%, P=0,001), enquanto a incidência de IAM foi semelhante (5,8% vs. 5,5%; P=0,87). Maior número de pacientes do G1 necessitou de RRH (12,1% vs. 6,1%; P=0,003). Da mesma forma, no G1 houve maior incidência de complicações respiratórias (21,4% vs. 9,1%; P<0,001), mediastinite (5,1% vs. 1,9%; P=0,013), AVE (3,9% vs. 1,3%; P=0,016), IRA (7,8% vs. 1,3%, P<0,001), sepse (3,9% vs. 1,9%; P=0,003), fibrilação atrial (15,6% vs. 9,8%; P=0,016) e BAVT (3,5% vs. 1,2%; P=0,023) do que o G2. Não houve diferença significante na necessidade de BIA. Na análise regressão logística multivariada “forward stepwise”, a idade ³ 70 anos foi fator preditivo independente para maior.
Objective: To analyze the results of isolated on-pump coronary artery bypass graft surgery (CABG) in patients ≥ 70 years-old in comparison to patients <70 years-old. Methods: Patients undergoing isolated CABG were selected for the study. The patients were grouped in G1 (age ≥ 70 years-old) and G2 (age <70 years-old). The endpoints were in-hospital mortality, acute myocardial infarction (AMI), stroke, reexploration for bleeding, intra-aortic balloon for circulatory shock, respiratory complications, acute renal failure, mediastinitis, sepsis, atrial fibrillation, and complete atrioventricular block (CAVB). Results: 1,033 patients were included, 257 (24.8%) in G1 and 776 (75.2%) in G2. Patients in G1 were more likely to have in-hospital mortality than G2 (8.9% vs. 3.6%, respectively; P=0.001), while the incidence of AMI was similar (5.8% vs. 5.5%; P=0.87) than G2. More patients in G1 had re-exploration for bleeding (12.1% vs. 6.1%; P=0.003). G1 had more incidence of respiratory complications (21.4% vs. 9.1%; P<0.001), mediastinitis (5.1% vs. 1.9%; P=0.013), stroke (3.9% vs. 1.3%; P=0.016), acute renal failure (7.8% vs. 1.3%; P<0.001), sepsis (3.9% vs. 1.9%;P=0.003), atrial fibrillation (15.6% vs. 9.8%; P=0.016), and CAVB (3.5% vs. 1.2%; P=0.023) than G2. There was no significant difference in the use of intra-aortic balloon. In the forward stepwise multivariate logistic regression analysis age ≥ 70-year-old was an independent predictive factor for higher in-hospital mortality (P=0.004), reexploration for bleeding (P=0.002), sepsis (P=0.002), respiratory complications (P<0.001), mediastinitis (P=0.016), stroke (P=0.029), acute renal failure (P<0.001), atrial fibrillation (P=0.021) and CAVB (P=0.031). Conclusion: This study suggests that patients ≥ 70 yearsold were at increased risk of death and other complications in the CABG’s postoperative period in comparison to younger patients.
Objective: To analyze the results of isolated on-pump coronary artery bypass graft surgery (CABG) in patients ≥ 70 years-old in comparison to patients <70 years-old. Methods: Patients undergoing isolated CABG were selected for the study. The patients were grouped in G1 (age ≥ 70 years-old) and G2 (age <70 years-old). The endpoints were in-hospital mortality, acute myocardial infarction (AMI), stroke, reexploration for bleeding, intra-aortic balloon for circulatory shock, respiratory complications, acute renal failure, mediastinitis, sepsis, atrial fibrillation, and complete atrioventricular block (CAVB). Results: 1,033 patients were included, 257 (24.8%) in G1 and 776 (75.2%) in G2. Patients in G1 were more likely to have in-hospital mortality than G2 (8.9% vs. 3.6%, respectively; P=0.001), while the incidence of AMI was similar (5.8% vs. 5.5%; P=0.87) than G2. More patients in G1 had re-exploration for bleeding (12.1% vs. 6.1%; P=0.003). G1 had more incidence of respiratory complications (21.4% vs. 9.1%; P<0.001), mediastinitis (5.1% vs. 1.9%; P=0.013), stroke (3.9% vs. 1.3%; P=0.016), acute renal failure (7.8% vs. 1.3%; P<0.001), sepsis (3.9% vs. 1.9%;P=0.003), atrial fibrillation (15.6% vs. 9.8%; P=0.016), and CAVB (3.5% vs. 1.2%; P=0.023) than G2. There was no significant difference in the use of intra-aortic balloon. In the forward stepwise multivariate logistic regression analysis age ≥ 70-year-old was an independent predictive factor for higher in-hospital mortality (P=0.004), reexploration for bleeding (P=0.002), sepsis (P=0.002), respiratory complications (P<0.001), mediastinitis (P=0.016), stroke (P=0.029), acute renal failure (P<0.001), atrial fibrillation (P=0.021) and CAVB (P=0.031). Conclusion: This study suggests that patients ≥ 70 yearsold were at increased risk of death and other complications in the CABG’s postoperative period in comparison to younger patients.
Description
Palavras-chave
Revascularização miocárdica, Mortalidade
hospitalar, Complicações pós-operatórias, Idoso, Myocardial revascularization, Hospital
mortality, Postoperative complications, Aged
Citação
Rocha ASC, Pitella F, De Lorenzo A, Brazan V, Colafranceschi AS, Brito JOR, et al. A idade influencia os desfechos em pacientes com idade igual ou superior a 70 anos submetidos à cirurgia de revascularização miocárdica isolada. Rev Bras Cir Cardiovasc. 2012;27(1):45-51.