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In-hospital mortality and long-term survival after coronary artery bypass surgery in young patients.
MedLine Citation:
PMID:  23137563     Owner:  NLM     Status:  Publisher    
OBJECTIVES: Coronary artery bypass graft (CABG) is performed for symptomatic and prognostic reasons. We aimed to determine the factors that contribute to in-hospital mortality and long-term survival in young patients (aged less than 65) undergoing CABG. METHODS: A prospective database was retrospectively analysed and cross-correlated with the United Kingdom's Strategic Tracing Service to evaluate survival in patients under the age of 65, following isolated primary CABG. Univariate-, multivariate logistic with Cox regression- and neural network analyses were performed. RESULTS: Patients under the age of 65, who had undergone isolated CABG between April 1997 and March 2010 were studied;n = 5967. In-hospital mortality was 1.1% and long-termmortality was 13.5%; median follow-up 7.9 years. Multivariate analysis demonstrated that atrial fibrillation, 'urgent' operation status, postoperative creatinine kinase (CKMB), moderate or poor left ventricular (LV) function, and female sex were significant factors predicting in-hospital mortality. Cox regression demonstrated that age, diabetes (oral and insulin controlled), moderate and poor LV function, cerebrovascular disease, dialysis, left internal mammary artery (LIMA) usage, postoperative CKMB, atrial fibrillation, 'urgent' operation status, and peripheral vascular disease were significant factors determining long-term survival. Radial artery use, off-pump surgery, composite arterial grating and graft number had no effect on in-hospital mortality or long-term survival. Neural network analysis confirmed the factors identified by logistic and Cox multivariate analysis. CONCLUSIONS: The risk factors for in-hospital mortality in patients under the age of 65 include postoperative CKMB, urgent operation status, LV function, female sex and atrial fibrillation. Significant factors determining long-term survival in the under-65 age group include age, atrial fibrillation, diabetes (diet and insulin controlled), LV function, cerebrovascular disease, dialysis, LIMA usage, 'urgent' operation status, CKMB and peripheral vascular disease.
Neeraj Mediratta; John Chalmers; Mark Pullan; James McShane; Mathew Shaw; Michael Poullis
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-8
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  -     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
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