Myocardial revascularization surgery: short and long-term survival analysis
DOI:
https://doi.org/10.23938/ASSN.0934Keywords:
Coronary artery bypass surgery, Myocardial revascularization, Treatment outcome, Survival, Prognostic factorsAbstract
Background. This study sets out to describe the survival and clinical evolution of patients who undergo myocardial revascularisation surgery, and identifies the short- and long-term predictive factors for surgical outcomes.
Methods. Study of a cohort of 175 patients undergoing pure or mixed coronary myocardial revascularisation surgery at a heart surgery unit, recruited between 2008 and 2010 and monitored for ten years. Descriptive and logistic regression (OR and 95%CI) analysis were carried out, along with an analysis of survival by Kaplan Meier and Cox uni- and multivariate regression (HR and 95%CI) in the short- (one year) and long-term (ten years).
Results. Predominantly male cohort (85.1%), mean age of 67 years (45-84), and mean EuroSCORE of 5.3%. Mortality was 6.8 and 26.9% at 1 and 10 years, respectively. Mean survival of deceased individuals was 40 months (32.2-47.8). In the short-term, a better NYHA ≤III preoperative functional level was not significantly associated with lower mortality (OR: 0.11; 95%CI: 0.01-1.08; p=0.058), while being female (OR: 2.94; 95%CI: 1.01-8.57; p=0.048) and having a EuroSCORE of >4% (OR: 4.94; 95%CI: 1.52-16.10; p=0.008) showed an increased risk of presenting adverse cardiac events. In the long-term, greater age (HR: 1.06; 95%CI: 1.01-1.10; p=0.026) and lower rates of body mass index after the first postoperative year (HR: 0.90; 95%CI: 0.81-0.99; p=0.040) were independent predictors of mortality.
Conclusion. Age was an independent predictor of long-term mortality, while being female and a EuroSCORE >4% were associated with a higher risk of suffering from short-term cardiovascular events.
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References
OMS. Estimaciones de salud global 2016. Muertes por causa, edad, sexo, país y región. 2000-2016. Ginebra. OMS. Disponible en: https://www.who.int/healthinfo/global_burden_disease/estimates/en/ Consultado 29/05/2020.
ALONSO JJ, CURCIO A, CRISTÓBAL C, TARÍN MN, SERRANO JM, TALAVERA P et al. Indicaciones de revascularización: aspectos clínicos. Rev Esp Cardiol 2005; 58: 198-216. https://doi.org/10.1157/13071894
CID AB, RODRÍGUEZ O, MORENO R, PÉREZ DE PRADO A. Registro Español de Hemodinámica y Cardiología Intervencionista. XXVII Informe Oficial de la Sección de Hemodinámica y Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2017). Rev Esp Cardiol 2018; 71: 1036-1046. https://doi.org/10.1016/j.recesp.2018.07.024
CUERPO G, CARNERO M, HORNERO F, POLO L, CENTELLA T, GASCÓN P et al. Cirugía cardiovascular en España en el año 2018. Registro de intervenciones de la Sociedad Española de Cirugía Torácica-Cardiovascular. Cir Cardiov 2019; 26: 248-264. https://doi.org/10.1016/j.circv.2019.10.002
MYERS WO, BLACKSTONE EH, DAVIS K, FOSTER ED, KAISER GC. CASS Registry long term surgical survival. Coronary Artery Surgery Study. J Am Coll Cardiol 1999 Feb; 33: 488-498. https://doi.org/10.1016/s0735-1097(98)00563-4
HANNAN EL, KILBURN H JR, RACZ M, SHIELDS E, CHASSIN MR. Improving the outcomes of coronary artery bypass surgery in New York State. JAMA 1994 Mar 9; 271: 761-766. https://doi.org/10.1097/00132586-199410000-00052
HAWKES AL, NOWAK M, BIDSTRUP B, SPEARE R. Outcomes of coronary artery bypass graft surgery. Vasc Health Risk Manag 2006; 2: 477-484. https://doi.org/10.2147/vhrm.2006.2.4.477
PERMANYER C, BROTONS C, RIBERA A, MORAL I, CASCANT P, ALONSO J et al. Resultados clínicos y de calidad de vida de los pacientes tratados con angioplastia coronaria con balón o stent. Estudio multicéntrico prospectivo. Rev Esp Cardiol 2001; 54: 597-606. https://doi.org/10.1016/s0300-8932(01)76362-2
RIBERA A, FERREIRA-GONZÁLEZ I, CASCANT P, MARSAL JR, ROMERO B, PEDROL D et al. Survival, clinical status and quality of life five years after coronary surgery. The ARCA study. Rev Esp Cardiol 2009 Jun; 62: 642-651. https://doi.org/10.1016/s1885-5857(09)72228-5
PERMANYER C, BROTONS C, RIBERA A, MORAL I, CASCANT P, ALONSO J et al. Desigual perfil clínico, calidad de vida y mortalidad hospitalaria en pacientes operados de injerto aortocoronario en centros públicos y privados de Cataluña. Rev Esp Cardiol 1998; 51: 806-815.
LÓPEZ FJ, GONZÁLEZ JM, DALMAU MJ, BUENO M. Cirugía cardiaca en el anciano: comparación de resultados a medio plazo entre octogenarios y ancianos de 75 a 79 años. Rev Esp Cardiol 2008 ;61: 579-588. https://doi.org/10.1157/13123063
RIERA M, HERRERO J, IBAÑEZ J, CAMPILLO C, AMÉZAGA R, SÁEZ DE IBARRA et al. Supervivencia a medio plazo de los pacientes operados en cirugía cardiaca mayor. Rev Esp Cardiol 2011; 64: 463-469. https://doi.org/10.1016/j.recesp.2010.12.015
NAVARRO MA, DE CARLOS V. Calidad de vida relacionada con la salud dos años después de cirugía de revascularización miocárdica. An Sist Sanit Navar 2020 Dec 22; 43: 333-345. https://doi.org/10.23938/ASSN.0912
ROQUES F, MICHEL P, GOLDSTONE AR, NASHEF SAM. The logisticEuroSCORE. Eur Heart J 2003; 24: 1-2. https://doi.org/10.1016/S0195-668X(02)00799-6
LAFUENTE S, TRILLA A, BRUNI L, GONZÁLEZ R, BERTRÁN MJ, POMAR JL et al. Validación del modelo probabilístico EuroSCORE en pacientes intervenidos de injerto coronario. Rev Esp Cardiol 2008; 61: 589-594. https://doi.org/10.1157/13123064
NAVARRO MA, MARIN B, DE CARLOS V, MARTÍNEZ A, MARTORELL A, ORDOÑEZ E et al. Trastornos del ánimo preoperatorios en cirugía cardiaca: factores de riesgo y morbilidad postoperatoria en la unidad de cuidados intensivos. Rev Esp Cardiol 2011; 64: 1005-1010. https://doi.org/10.1016/j.recesp.2011.06.009
VILAGUT G, VALDERAS JM, FERRER M, GARIN O, LÓPEZ-GARCÍA E, ALONSO J. Interpretation of SF-36 and SF-12 questionnaires in Spain: physical and mental components. Med Clin (Barc) 2008 May 24; 130: 726-735. https://doi.org/10.1157/13121076
TEIXEIRA R, LOURENÇOA C, ANTÓNIOA N, JORGEA E, BAPTISTAA R, SARAIVAA F et al. ¿Podemos mejorar la evolución de los pacientes con antecedentes de cirugía de bypass coronario ingresados por un síndrome coronario agudo? Rev Esp Cardiol 2010; 63: 554-563. https://doi.org/10.1016/s0300-8932(10)70117-2
PERMANYER C, BROTONS C, RIBERA S, ALONSO J, CASCANT P, MORAL I. Resultados después de cirugía coronaria: determinantes de calidad de vida relacionada con la salud postoperatoria. Rev Esp Cardiol 2001; 54: 607-616. https://doi.org/10.1016/s0300-8932(01)76363-4
BUFFOLO E, JUFFÉ STEIN A. Study SYNTAX, from the evidence to the disobedience. Cir Cardiov 2013; 20: 52-54. http://dx.doi.org/10.5935/1678-9741.20130023
THUIJS D, KAPPETEIN AP, SERRUYS PW, MOHR FW, MARIE-CLAUDE MORICE MC, MACK MJ et al. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial. Lancet 2019 Oct 12; 394: 1325-1334. https://doi.org/10.1016/S0140-6736(19)31997-X
CHIKWE J, LEE T, ITAGAKI S, ADAMS DH, EGOROVA NN. Long-term outcomes after off-pump versus on-pump coronary artery bypass grafting by experienced surgeons. J Am Coll Cardiol 2018 Sep 25; 72: 1478-1486. https://doi.org/10.1016/j.jacc.2018.07.029
Instituto de Estadística de Navarra. Defunciones según la causa de muerte. Comunidad Foral de Navarra, 2018. Disponible en: https://www.navarra.es/home_es/Gobierno+de+Navarra/Organigrama/Los+departamentos/Economia+y+Hacienda/Organigrama/Estructura+Organica/Instituto+Estadistica/NotasPrensa/Defunciones.htm
Instituto Nacional de Estadística. Defunciones según la causa de muerte. 2018. https://www.ine.es/dyngs/INEbase/es/operacion.htm?c=Estadistica_C&cid=1254736176780&menu=ultiDatos&idp=1254735573175
NELSON CP, LAMBERT PC, SQUIRE IB, JONES DR. Relative survival: what can cardiovascular disease learn from cancer? Eur Heart J 2008; 29: 941-947. https://doi.org/10.1093/eurheartj/ehn079
DOENST T, IVANOV J, BORGER MA, DAVID TE, BRISTER SJ. Sex-specific long-term outcomes after combined valve and coronary artery surgery. Ann Thorac Surg 2006; 81: 1632-1636. https://doi.org/10.1016/j.athoracsur.2005.11.052
OHMAN EM, BHATT DL, STEG PG, GOTO S, HIRSCH AT, LIAU CS et al. The reduction of atherothrombosis for continued health (REACH) registry: an international, prospective, observational investigation in subjects at risk for atherothrombotic events-study design. Am Heart J 2006; 151: 786.e1-10. https://doi.org/10.1016/j.ahj.2005.11.004
UDELL JA, STEG PG, SCIRICA BM, SMITH SC JR, OHMAN EM, EAGLE KA et al. Living alone and cardiovascular risk in outpatients at risk of or with atherothrombosis. Arch Intern Med 2012; 172: 1086-1095. https://doi.org/10.1001/archinternmed.2012.2782
JENSEN MT, MAROTT JL, HOLTERMANN A, GYNTELBERG F. Living alone is associated with all-cause and cardiovascular mortality: 32 years of follow-up in the Copenhagen Male Study. Eur Heart J Qual Care Clin Outcomes 2019; 5: 208-217. https://doi.org/10.1093/ehjqcco/qcz004
NISSINEN J, BIANCARI F, WISTBACKA JO, LOPONEN P, TEITTINEN K, TARKIAINEN P et al. Is it possible to improve the accuracy of EuroSCORE? Eur J Cardiothorac Surg 2009; 36: 799-806. https://doi.org/10.1016/j.ejcts.2009.03.069
BIANCARI F, KANGASNIEMI OP, LUUKKONEN J, VUORISALO S, SATTA J, POKELA R et al. EuroSCORE predicts immediate and late outcome after coronary artery bypass surgery. Ann Thorac Surg 2006; 82: 57-61. https://doi.org/10.1016/j.athoracsur.2005.11.039
MICKLEBOROUGH LL, CARSON S, TAMARIZ M, IVANOV J. Results of revascularization in patients with severe left ventricular dysfunction. J Thorac Cardiovasc Surg 2000; 119: 550-557. https://doi.org/10.1016/s0022-5223(00)70135-8
OLIVEIRA SF, JATENE AD, SOLIMENE MC, DE OLIVEIRA SA, MENEGUETTI C, JATENE FB et al. Coronary artery bypass graft surgery in patients with ischemic cardiomyopathy and severe left ventricular dysfunction: short and long-term results. Heart Surg Forum 1999; 2: 47-53.
ZAPOLANSKI A, MAK A, FERRARI G, JOHNSON C, SHAW RE, BRIZZIO ME et al. Impact of New York Heart Association classification, advanced age and patient-prosthesis mismatch on outcomes in aortic valve replacement surgery. Interact Cardiovasc Thorac Surg 2012; 15: 371-376. https://doi.org/10.1093/icvts/ivs231
PRÊTRE R, TURINA MI. Cardiac valve surgery in the octogenarian. Heart 2000; 83: 116-121. https://doi.org/10.1136/heart.83.1.116
CALVO D, LOZANO I, LLOSA JC, LEE DH, MARTÍN M, AVANZAS P et al. Aortic valve replacement in octogenarians with severe aortic stenosis. experience in a series of consecutive patients at a single center. Rev Esp Cardiol 2007; 60: 720-726. https://doi.org/10.1016/s1885-5857(08)60007-9
LANGANAY T, DE LATOUR B, LIGIER K, DERIEUX T, AGNINO A, VERHOYE JP et al. Surgery for aortic stenosis in octogenarians: influence of coronary disease and other comorbidities on hospital mortality. J Heart Valve Dis 2004; 13: 545-552.
OREOPOULOS A, PADWAL R, KALANTAR-ZADEH K, FONAROW GC, NORRIS CM, MCALISTER FA. Body mass index and mortality in heart failure: a meta-analysis. Am Heart J 2008; 156: 13-22. https://doi.org/10.1016/j.ahj.2008.02.014
TRULLÁS JC, FORMIGA F, MONTERO M, CONDE A, CASADO J, CARRASCO FJ et al. Paradoja de la obesidad en la insuficiencia cardiaca. Resultados del Registro RICA. Med Clin (Barc) 2011; 137: 671-677. https://doi.org/10.1016/j.medcli.2011.03.036
LÓPEZ F, CORTÉS M. Obesidad y corazón. Rev Esp Cardiol 2011; 64: 140-149. https://doi.org/10.1016/j.recesp.2010.10.010
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