Coronary Artery Bypass Grafting Among Older Adults: Patterns, Outcomes, and Trends

Predictors of Premature Mortality Following Coronary Artery Bypass Grafting: An Iranian Single-Centre Study

Modifiable risk factors play an important role in the premature mortality among patients undergoing coronary artery bypass grafting (CABG). The aim of this study was to examine the factors that influence the early death of patients who had CABG. We conducted a prospective cohort study and followed 2863 patients after their CABG, and collected data on their characteristics and blood tests. We used the Cox proportional hazards regression model in Stata, version 16, to identify the predictors of early mortality. Out of 2863 patients, 162 died during the follow-up period. The survival rate was 99.2% within the first three days after the surgery, 96.2% from the fourth day to the end of the first year, 94.9% at the end of the second year, and 93.6% at the end of the third year. After adjusting for confounding factors, we found that older age (hazard ratio [HR] 1.05, 95% CI 1.02, 1.08 for one year increase in age), obesity (HR 2.16, 95% CI 1.25, 3.72), ejection fraction < 50% (HR 1.61, 95% CI 1.06, 2.44), number of rehospitalizations (HR 2.63, 95% CI 1.35, 5.12 for two or more readmissions), history of stroke (HR 2.91, 95% CI 1.63, 5.21), living in rural areas (HR 1.58, 95% CI 1.06, 2.34), opium use (HR 2.08, 95% CI 1.40, 3.09), and impaired glomerular filtration rate increased the risk of early death after CABG, while taking a beta-blocker (HR 0.59, 95% CI 0.38, 0.91) reduced the risk. We conclude that modifiable risk factors such as excess body mass, high blood glucose, opium use, and kidney dysfunction should be monitored and managed in patients who had CABG to improve their survival outcomes.

Pleiotropic Effects of Acetylsalicylic Acid after Coronary Artery Bypass Grafting-Beyond Platelet Inhibition

Acetylsalicylic acid (ASA) is one of the most frequently used medications worldwide. Yet, the main indications for ASA are the atherosclerosis-based cardiovascular diseases, including coronary artery disease (CAD). Despite the increasing number of percutaneous procedures to treat CAD, coronary artery bypass grafting (CABG) remains the treatment of choice in patients with multivessel CAD and intermediate or high anatomical lesion complexity. Taking into account that CABG is a potent activator of inflammation, ASA is an important part in the postoperative therapy, not only due to ASA antiplatelet action, but also as an anti-inflammatory agent. Additional benefits of ASA after CABG include anticancerogenic, hypotensive, antiproliferative, anti-osteoporotic, and neuroprotective effects, which are especially important in patients after CABG, prone to hypertension, graft occlusion, atherosclerosis progression, and cognitive impairment. Here, we discuss the pleiotropic effects of ASA after CABG and provide insights into the mechanisms underlying the benefits of treatment with ASA, beyond platelet inhibition. Since some of ASA pleiotropic effects seem to increase the risk of bleeding, it could be considered a starting point to investigate whether the increase of the intensity of the treatment with ASA after CABG is beneficial for the CABG group of patients.