Predictors of cardiovascular events in patients with chronic heart disease after surgical myocardial revascularization (according to the data of a long-term observation)

Aim. To elucidate independent predictors of fatal and nonfatal cardiovascular events in patients with chronic heart disease (CHD) after surgical myocardial revascularization during a long-term prospective observation. Subjects and methods. The study enrolled 120 patients with CHD who had undergone coronary artery bypass grafting with extracorporeal circulation. Further 2-5-year follow-ups recorded deaths from cardiac causes, including sudden deaths, as well as the incidence of nonfatal cardiovascular events (myocardial infarction, stroke). Results. The mean follow-up time was 36±5 months. During the follow-ups, there were 12 deaths: 1 and 8 deaths from pneumonia and myocardial infarction, respectively; 3 patients died suddenly. Out of the nonfatal events, myocardial infarction and stroke were recorded in 7 and 2 cases, respectively. Stepwise regression analysis showed that the independent predictors of fatal cardiac events were as follows: 1) an ejection fraction of less than 40% (relative risk 5.7 with deviations within 95% confidence interval, 1,2–10,7); 2) age of 70 years or older (4,9; 1,4–8,4); 3) diabetes mellitus (2,3; 1,1–3,7); 4) left ventricular aneurysm (2,1; 1,04–3,8); 5) mechanical ventilation for more than 24 hours (2,0; 1,2–2,9); 6) chronic obstructive pulmonary disease (1,9; 1,1–3,1). The independent predictors of all cases of both fatal and nonfatal cardiovascular events were: 1) age of 70 years or older (4,1; 1,2–8,1); 2) an ejection fraction of less than 40% (3,7; 1,1–6,5); 3) endarterectomy during coronary artery bypass grafting (2,9; 1,1–5,4); 4) mechanical ventilation for more than 100 minutes (2,2; 1,2–3,9); damage to the brachiocephalic artery area (2,1; 1,1–6,4), prior stroke (1,8; 1,1–3,8). Conclusion. The conducted study indicated the implication of both the poor traditional predictors of CHD and comorbidity, as well as the specific features of surgical intervention and anesthetic maintenance in the development of further fatal and nonfatal cardiovascular events in patients with CHD after surgical myocardial revascularization.

coronary heart disease, coronary artery bypass grafting, prognosis, cardiovascular events