Major Adverse Cardiac Events after first time elective isolated Coronary Artery

Abstract

Background Major adverse cardiovascular events (MACE) are useful endpoints to evaluate cardiovascular outcomes. The aim of this study was to report our results in concordance with the expected improvement of records after using the online Research Electronic Data Capture (RedCap) software. Methods: We included patients who benefited from first time elective isolated coronary bypass grafting (CABG) at Ain-Shams university main hospital, in the period between April 2014 and April 2016; providing a minimum 2 years follow-up . Incidences, risk factors and independent predictors for MACE were calculated including; mortality, the occurrence or re-hospitalization for: heart failure, recurrence of angina or myocardial infarction (MI), cerebrovascular stroke (CVS), need of coronary angiography (CA), repeat percutaneous intervention (PTCA) or CABG. Results: 607 cases met our inclusion criteria and 105 patients (18.7%) developed 184 MACE, including 45 hospital mortalities (7.4%), 13 late mortalities (2.1%) and 126 non-fatal events recorded in 47 patients (7.7%); a majority (40 patients; 6.6%) had suffered from at least 3 non-fatal events. Two-years follow-up was complete for the 562 hospital survivors with a total of 1113 patient-years. The annualized incidence rates of ICU admission, repeated angina or MI, need for CA, PTCA, or CABG, development of CVS, heart failure, and late mortality were: 3.6%, 2.8%, 1.8%, 0.5%, 0.09%, 0.35%, 2% and 1.2% per patient-year; respectively. Independent predictors of hospital mortality were: advanced age at surgery (OR 1.06: 1-1.12; P = 0.049), female sex (OR 3.4: 1.3-8.9; P = 0.01), prolonged durations of: cardiopulmonary bypass CPB (OR 1.02: 1.01- 1.04; P < 0.001), mechanical ventilation (OR 1.07: 1.04- 1.09; P < 0.001) positive inotropic support (OR 1.03: 1.02- 1.05; P < 0.001) and ICU stay (OR 1.09: 1.07- 1.11; P < 0.001). Independent predictors of overall MACE were advanced age at surgery (OR 1.04: 1.01-1.07; P = 0.011), prolonged durations of: aortic cross clamp (OR 1.09: 1.04-1.11; P = 0.003), CPB (OR 1.06: 1.04-1.08; P < 0.001) and mechanical ventilation (OR 1.02: 1.01-1.03; P < 0.001). Conclusion: Our results suggested that more care should be given to females, elderly and to shorten and improve the quality of our operative times. The repetition of non-fatal MACE could be modified by closer observation of the patient, once developing his first event.