Impact of Pre-, Intra-and Post-Operative Parameters on In-Hospital Mortality in Patients Undergoing Emergency Coronary Artery Bypass Grafting: A Scarce Single-Center Experience in Resource-Scare Setting

Figures & data

Figure 1 Trends in in-mortality survival and in-hospital mortality after emergency CABP.

Table 1 Difference of Preoperative Data Among In-Hospital Mortality Patient Group and In-Hospital Survival Patient Group

Preoperative Variables	All Patients (n = 71)	In-Hospital Mortality		p value
		No (n = 64)	Yes (n = 7)
	Count (% of Total)	Count (% of Total)	Count (% of Total)
Gender				1.000^F
Male	47 (66.20)	42 (65.62)	5 (71.43)
Female	24 (33.80)	22 (34.38)	2 (28.57)
Diabetes	24 (33.80)	19 (29.69)	5 (71.43)	0.040^F
Hypertension	65 (91.55)	58 (90.62)	7 (100.00)	1.000^F
Lipid disorder	28 (39.44)	27 (42.19)	1 (14.29)	0.232^F
Smoking	32 (45.07)	29 (45.31)	3 (42.86)	0.031^F
COPD	4 (5.63)	4 (6.25)	0 (0.00)	1.000^F
History of cerebrovascular accident	6 (8.82)	6 (9.68)	0 (0.00)	1.000^F
PVD	16 (22.54)	15 (23.44)	1 (14.29)	1.000^F
History of PCI	10 (14.08)	10 (15.62)	0 (0.00)	0.582^F
ST segment elevation myocardial infarction	30 (42.25)	25 (39.06)	5 (71.43)	0.125^F
ECG results				1.000^F
Sinus rhythm	69 (97.18)	62 (96.88)	7 (100.00)
Atrial rhythm	2 (2.82)	2 (3.12)	0 (0.00)
Echocardiography
Local movement disorders	53 (74.65)	46 (71.88)	7 (100.00)	0.179^F
Pericardial fluid	6 (8.45)	6 (9.38)	0 (0.00)	1.000^F
Ventricular septal perforation	2 (2.82)	2 (3.12)	0 (0.00)	1.000^F
Mitral valve regurgitation due to mechanical complications	3 (4.23)	3 (4.69)	0 (0.00)	1.000^F
Severe valve regurgitation	22 (30.99)	19 (29.69)	3 (42.86)	0.669^F
EF below 30%	11 (15.49)	7 (10.94)	4 (57.14)	0.009^F
Coronary lesions in coronary angiography (n = 70)				0.361^F
Left main	4 (5.71)	4 (6.35)	0 (0.00)
Three-vessel with left main	33 (47.14)	27 (42.86)	6 (85.71)
Three-vessel without left main	25 (35.71)	24 (38.10)	1 (14.29)
Two-vessel without left main^+	1 (1.43)	1 (1.59)	0 (0.00)
One-vessel	7 (10.00)	7 (11.11)	0 (0.00)
Antiplatelet drugs
Aspirin	69 (97.18)	62 (96.88)	7 (100.00)	1.000^F
Clopidogrel	55 (77.46)	48 (75.00)	7 (100.00)	0.337^F
Ticagrelor	26 (36.62)	24 (37.50)	2 (28.57)	1.000^F
Surgical indication				0.002^F
Progressive myocardial infarction	41 (57.75)	41 (64.06)	0 (0.00)
Cardiogenic shock	17 (23.94)	12 (18.75)	5 (71.43)
Accidents of cardiovascular intervention*	6 (8.45)	5 (7.81)	1 (14.29)
Mechanic complications of acute myocardial infarction**	7 (9.86)	6 (9.38)	1 (14.29)
	Mean±SD (IQR)	Mean±SD (IQR)	Mean±SD (IQR)
Age (year)	68.68±9.28 (38–86)	68.16±9.37 (38–86)	73.43±7.37 (64–86)	0.1549^T
Weight (kg)	54.35±9.17 (37–77)	54.48±9.24 (37–77)	53.14±9.10 (45–70)	0.7161^T
Height (cm)	158.96±7.64 (145–179)	158.72±7.55 (145–179)	161.42±8.69 (147–170)	0.4291^T
BMI (kg/m^2)	21.48±3.08 (13.59–30.08)	21.60±3.10 (13.59–30.08)	20.44±2.87 (16.65–26.03)	0.3498^T
Serum creatinine (mmol/L)	98.31±45.19 (50–351)	94.97±43.66 (50–351)	128.86±51.01 (68–226)	0.0265^M
EF (%)	47.01±15.97 (20–76)	48.98±15.42 (24–76)	29±7.53 (20–40)	0.0016^M
LV dimensions in diastole (mm)	48.58±7.13 (33–67)	48.23±7.11 (33–67)	51.71±7.02 (43–63)	0.2226^T
Systolic PAP (mmHg)	32.37±9.66 (20–60)	31.41±9.18 (20–60)	41.14±10.14 (25–53)	0.0153^M
Troponin-T (ng/L) (n = 60)	1707.70±3303.72 (12–22159)	1320.17±1922.10 (12–10000)	4641.86±7996.05 (29–221590)	0.3393^M
CK-MB (U/L) (n = 53)	88.36±115.32 (6.4–658)	77.98±104.70 (7.9–658)	169.65±168.84 (6.4–387)	0.2861^M
NT-ProBNPpg/mL) (n = 45)	4498.92±5850.80 (92–35000)	3424.60±3389.52 (92–12937)	15510.75±13093.04 (6853–35000)	0.0059^M
Euroscore II	14.69±13.58 (0.95–53.2)	12.80±1.93 (0.95–53.2)	32.05±16.32 (4.48–49.11)	0.0058^M

Notes: *Cases of acute cardiac tamponade due to coronary perforation, 2 cases of coronary artery dissection (1 left main dissection and 1 right coronary artery dissection), 1 case of left main injury when placing a stent in the circumflex artery; **3 cases of left ventricular free-wall rupture, 2 cases of acute mitral regurgitation due to papillary muscle rupture, and 2 cases of interventricular septal rupture; ⁺Circumflex artery and right coronary artery, left anterior descending artery and right coronary artery; Significance level at p < 0.05 was given in bold.

Abbreviations: COPD, chronic obstructive pulmonary disease; PVD, peripheral vascular disease; PCI, percutaneous coronary intervention; BMI, body mass index; PAP, pulmonary artery pressure; EF, ejection fraction; CK-MB, creatine kinase–myocardial band; M, Mann–Whitney U-test; T, t-test; F, Fisher’s exact test.

Table 2 Difference of Intraoperative Data Among In-Hospital Mortality Patient Group and In-Hospital Survival Patient Group

Intraoperative Variables	All Patients (n = 71)	In-Hospital Mortality		p value
		No (n = 64)	Yes (n = 7)
	Count (% of Total)	Count (% of Total)	Count (% of Total)
CPB	70 (98.59)	63 (98.44)	7 (100.00)	1.000^F
Left internal thoracic artery	55 (77.46)	52 (81.25)	3 (42.86)	0.041^F
Saphenous veins	68 (95.77)	61 (95.31)	7 (100.00)	1.000^F
Radial artery	5 (7.04)	5 (7.81)	0 (0.00)	1.000^F
Number of distal anastomosis				0.281^F
1	8 (11.27)	7 (10.94)	1 (14.29)
2	12 (16.90)	12 (18.75)	0 (0.00)
3	19 (26.76)	17 (26.56)	2 (28.57)
4	30 (42.25)	27 (42.19)	3 (42.86)
5	2 (2.82)	1 (1.56)	1 (14.29)
Number of radialartery (n = 70)				0.100^F
0	65 (92.86)	58 (92.06)	7 (100.00)
1	3 (4.29)	3 (4.76)	0 (0.00)
2	2 (2.86)	2 (3.17)	0 (0.00)
Number ofsaphenous veins				0.010^F
0	3 (4.23)	3 (4.69)	0 (0.00)
1	16 (22.54)	15 (23.44)	1 (14.29)
2	23 (32.39)	22 (34.38)	1 (14.29)
3	25 (35.21)	23 (35.94)	2 (28.57)
4	4 (5.63)	1 (1.56)	3 (42.86)
Management of combined lesions during surgery	17 (23.94)	15 (23.44)	2 (28.57)	0.670^F
Aortic cross-clamping	68 (95.77)	61 (95.31)	7 (100,00)	0.100^F
	Mean±SD (IQR)	Mean±SD (IQR)	Mean±SD (IQR)
Aortic cross-clamping time (mins) (n = 68)	72.24±26.41 (30–167)	70.10±24.49 (30–152)	90.86±36.56 (63–167)	0.0861^M
Cardiopulmonary bypass time (mins) (n = 70)	101.31±37.30 (40–264)	96.67±31.44 (40–200)	143.14±59.27 (90–264)	0.0100^M

Note: Significance level at p < 0.05 was given in bold.

Abbreviations: CPB, cardiopulmonary bypass; M, Mann–Whitney U-test; F, Fisher’s exact test.

Table 3 Difference of Postoperative Data Among In-Hospital Mortality Group and In-Hospital Survival Group

Postoperative Variables	All Patients (n = 71)	In-Hospital Mortality		p value
		No (n = 64)	Yes (n = 7)
	Count (% of Total)	Count (% of Total)	Count (% of Total)
Postextubation respiratory failure requiring mechanical ventilation	7 (9.86)	4 (6.25)	3 (42.86)	0.018^F
Reoperation for bleeding	7 (9.86)	5 (7.81)	2 (28.57)	0.138^F
IABP	5 (7.04)	1 (1.56)	4 (57.14)	0.000^F
ECMO for acute heart failure	1 (1.41)	0 (0.00)	1 (14.29)	0.099^F
Ventricular fibrillation	8 (11.27)	4 (6.25)	4 (57.14)	0.002^F
New-onset atrial fibrillation	2 (2.82)	1 (1.56)	1 (14.29)	0.189^F
Dialysis-requiring acute renal failure	9 (12.68)	4 (6.25)	5 (71.43)	0.000^F
Pneumonia	17 (23.94)	12 (18.75)	5 (71.43)	0.007^F
Bacterial sepsis	4 (5.63)	1 (1.56)	3 (42.86)	0.002^F
Cerebrovascular accident	7 (9.86)	7 (10.94)	0 (0.00)	1.000^F
Ischemic stroke	4 (5.63)	4 (6.25)	0 (0.00)	1.000^F
Gastrointestinal bleeding	3 (4.23)	1 (1.56)	2 (28.57)	0.024^F
Peritonitis	1 (1.41)	1 (1.56)	0 (0.00)	1.000^F
Surgical wound infection	7 (9.86)	7 (10.94)	0 (0.00)	1.000^F
	Mean±SD (IQR)	Mean±SD (IQR)	Mean±SD (IQR)
Mechanical ventilation time (hours)	4.44±5.44 (1–32)	3.58±4.38 (1–32)	12.29±8.01 (4–26)	0.0003^M
24-hour post-operative mediastinal drainage value (mL)	452.82±420.59 (60–1930)	425.70±404.70 (60–1930)	700.71±514.28 (195–1700)	0.0791^M

Note: Significance level at p < 0.05 was given in bold.

Abbreviations: IABP, Intra-aortic balloon counterpulsation; ECMO, extracorporeal membrane oxygenation; M, Mann–Whitney U-test; F, Fisher’s exact test.

Table 4 Preoperative Risk Factors of In-Hospital Mortality in Patients Undergoing Emergency CABG: Univariate and Multivariable Regression Analysis

Preoperative Factors	In-Hospital Mortality
	Univariate Logistic Regression		Multivariate Logistic Regression
	OR	95% CI	OR	95% CI
Age	1.08	0.97–1.19
BMI	0.88	0.67–1.15
Gender
Male	REF
Female	0.76	0.14–4.26
Diabetes^A
No	REF		REF
Yes	5.92	1.05–33.24*	6.06	0.53–69.23
Hypertension
No	REF
Yes	-	-
Lipid disorder
No	REF
Yes	0.23	0.03–2.01
Smoking
No	REF
Yes	0.91	0.19–4.38
COPD
No	REF
Yes	-	-
History of cerebrovascular accident
No	REF
Yes	-	-
PVD
No	REF
Yes	0.54	0.06–4.88
History of PCI
No	REF
Yes	-	-
ST segment elevation myocardial infarction
No	REF
Yes	3.90	0.70–21.67
Local movement disorders
No	REF
Yes	-	-
Pericardial fluid
No	REF
Yes	-	-
Ventricular septal perforation
No	REF
Yes	-	-
Mitral valve regurgitation due to mechanical complications
No	REF
Yes	-	-
Severe valve regurgitation
No	REF
Yes	1.78	0.36–8.71
EF^A	0.87	0.77–0.97*	0.87	0.73–1.03
EF <30%
No	REF
Yes	10.86	2.00–58.86**
LV dimensions in diastole	1.07	0.96–1.20
ECG results
Sinus rhythm	REF
Atrial rhythm	-	-
Antiplatelet drugs
Aspirin
No	REF
Yes	-	-
Clopidogrel
No	REF
Yes	-	-
Ticagrelor
No	REF
Yes	0.67	0.12–3.71
Cardiogenic shock^A
No	REF		REF
Yes	10.83	1.87–62.71**	1.49	0.73–1.03
Accidents of PCI
No	REF
Yes	1.97	0.20–19.72
Serum creatinine	1.01	0.99–1.02
Systolic PAP^A	1.10	1.01–1.19*	1.01	0.90–1.13
Troponin-T	1.002	0.99–1.00
CK-MB	1.005	0.99–1.01
NT-ProBNP	1.0004	1.00002–1.0008*
Euroscore II^A	1.08	1.03–1.14**	1.02	0.94–1.10

Notes: *, **Significant at 0.05 and 0.01; ^ASignificant variables of univariate logistic regression models selected in multivariate logistic regression model.

Abbreviations: COPD, chronic obstructive pulmonary disease; PVD, peripheral vascular disease; PCI, percutaneous coronary intervention; BMI, body mass index; PAP, pulmonary artery pressure; EF, ejection fraction; OR, odd ratio; 95% CI, 95% confidence interval.

Table 5 Intraoperative Risk Factors of In-Hospital Mortality in Patients Undergoing Emergency CABG: Univariate and Multivariable Regression Analysis

Intraoperative Factors	In-Hospital Mortality
	Univariate Logistic Regression		Multivariate Logistic Regression
	OR	95% CI	OR	95% CI
CPB
No	REF
Yes	-	-
Left internal thoracic artery^A
No	REF		REF
Yes	0.17	0.03–0.88*	0.51	0.06–4.39
Saphenous veins
No	REF
Yes	-	-
Radial artery
No	REF
Yes	-	-
Number of distal anastomosis
1	REF
2	-	-
3	0.82	0.06–10.62
4	0.77	0.07–8.67
5	7.00	0.22–226.00
Number of radial artery
0	REF
1	-	-
2	-	-
Management of combined lesions during surgery
No	REF
Yes	1.31	0.23–7.44
Aortic cross-clamping
No	REF
Yes	-	-
Aortic cross-clamping time	1.02	0.99–1.05
Cardiopulmonary bypass time^A	1.03	1.01–1.05*	38.87	4.63–325.96**

Notes: *, **Significant at 0.05 and 0.01; ^ASignificant variables of univariate logistic regression models selected in multivariate logistic regression model.

Abbreviations: CPB, cardiopulmonary bypass; OR, odd ratio; 95% CI, 95% confidence interval.

Figure 2 The measurement of cardiopulmonary bypass time among in-hospital mortality patient group and in-hospital survival patient group.

Table 6 Postoperative Risk Factors of In-Hospital Mortality in Patients Undergoing Emergency CABG: Univariate and Multivariable Regression Analysis

Postoperative Factors	In-Hospital Mortality
	Univariate Logistic Regression		Multivariate Logistic Regression (Model 1)		Multivariate Logistic Regression (Model 2)
	OR	95% CI	OR	95% CI	OR	95% CI
Postextubation respiratory failure requiring mechanical ventilation^A
No	REF		REF		REF
Yes	11.25	1.85–68.54**	2.12	0.01–315.26	21.06	0.04–11344.01
Reoperation for bleeding
No	REF
Yes	4.72	0.72–30.83
IABP
No	REF				REF
Yes	84.00	7.04–1001.62***			4132.07	0.0001–1.68e+11
ECMO for acute heart failure
No	REF
Yes	-	-
Ventricular fibrillation^A
No	REF		REF		REF
Yes	20.00	3.28–121.84**	51.95	1.75–1546.01*	25.73	0.13–5195.26
New-onset atrial fibrillation
No	REF
Yes	10.5	0.58–189.98
Dialysis-requiring acute renal failure^A
No	REF		REF		REF
Yes	37.5	5.46–257.59***	23.21	0.39–1368.4	1.23	1.52e-06–997577.30
Pneumonia^A
No	REF		REF		REF
Yes	10.83	1.87–62.71**	0.41	0.002–69.90	0.40	1.01e-08–1.61e+07
Bacterial sepsis^A
No	REF		REF		REF
Yes	47.25	3.96–563.42**	222.87	0.54–92031.44	2864.08	0.0001–6.55e+10
Cerebrovascular accident
No	REF
Yes	-	-
Ischemic stroke
No	REF
Yes	-	-
Gastrointestinal bleeding^A
No	REF		REF		REF
Yes	25.20	1.93–328.39*	66.34	0.66–6690.93	22467.70	0.0001–6.51e+12
Peritonitis
No	REF
Yes	-	-
Surgical wound infection
No	REF
Yes	-	-
Mechanical ventilation time^A	1.20	1.05–1.37**	0.83	(0.61–1.13)	0.54	0.18–1.63
24-hour post-operative mediastinal drainage value	1.001	0.999–1.002

Notes: *, **, ***Significant at 0.05, 0.01 and 0.001; ^ASignificant variables of univariate logistic regression models selected in multivariate logistic regression models (Model 1: not included the variable “IABP”; Model 2: included the variable “IABP”).

Abbreviations: IABP, intra-aortic balloon counterpulsation; ECMO, extracorporeal membrane oxygenation.

Figure 3 The incidence of in-hospital mortality in postoperative ventricular fibrillation group and without postoperative ventricular fibrillation.