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Al-Omary MS, Williams T, Brienesse SC, Khan A, Graffen S, Sheehan A, Doolan M, Walker R, Boyle AJ, Mejia R, Collins N. Impact of Delay in Surgery on Outcome in Patients Undergoing Cardiac Revascularisation Surgery. Heart Lung Circ 2020; 30:888-895. [PMID: 33199183 DOI: 10.1016/j.hlc.2020.09.935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/09/2020] [Accepted: 09/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Diagnosis of critical coronary artery disease, including after acute coronary syndrome presentation (ACS), represents an important indication for early coronary artery bypass graft (CABG) surgery. The study aims to investigate the influence of time from diagnosis to CABG on outcomes and document barriers to early revascularisation. METHODS All patients 18 years and older with an acute presentation due to ACS or critical coronary artery disease who were considered to require urgent inpatient cardiac surgery between January 2016-February 2019 were included in the study. The primary endpoints were 30-day all-cause mortality or readmission, 1-year all-cause mortality, all-cause readmission. The secondary endpoint was the rate of complications while waiting for surgery. The time duration between diagnostic coronary angiography and surgery was considered as the time interval. RESULTS Of 266 eligible patients, 251 underwent surgical revascularisation with 15 (6%) not undergoing surgery due to preoperative complications (n=12) or due to perceived prohibitively high surgical risk (n=3). The majority (85%) were male (mean age 67 years), 37% of patients had diabetes and 71% had hypertension. Non-ST elevation myocardial infarction was documented in 51% of the patients. The median time between diagnosis and inpatient CABG was 7 days (IQR 5-11). Thirty-five per cent (35%) of patients experienced complications while awaiting surgery. Of the 266 patients, 140 patients (53% - cohort 1) underwent surgery within 7 days. The cohort 1 rate of complications was lower than in cohort 2 (surgery after 7 days) (24 vs 47%, p<0.001). Moreover, 1-year mortality was less in cohort 1 (2 vs 8%, p=0.029). CONCLUSION In patients requiring urgent inpatient CABG, delay for more than 7 days is associated with a higher rate of in-hospital complications and worse 30 day and 12-month outcomes.
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Affiliation(s)
- Mohammed S Al-Omary
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia. https://twitter.com/alomarymsami
| | - Trent Williams
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | | | - Arshad Khan
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Simon Graffen
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Ayrton Sheehan
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Moira Doolan
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Rhonda Walker
- Cardiac and Stroke Outcome Unit, Hunter New England Area Local Health District, Newcastle, NSW, Australia
| | - Andrew J Boyle
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Rosauro Mejia
- Cardiothoracic Surgical Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Nicholas Collins
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.
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