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Zahara R, Soeharto DF, Widyantoro B, Sugisman, Herlambang B. Validation of EuroSCORE II Scoring System on Isolated CABG Patient in Indonesia. Egypt Heart J 2023; 75:86. [PMID: 37828408 PMCID: PMC10570231 DOI: 10.1186/s43044-023-00410-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/30/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Coronary Artery Bypass Graft (CABG) is one solution to overcome cardiovascular problems. EuroSCORE II is a scoring system to predict mortality risk in patients undergoing cardiac surgery including CABG. Unfortunately, there's still much debate about the benefits of EuroSCORE II in Asia, including Indonesia. This study aims to validates EuroSCORE II in predicting the outcomes in patients underwent CABG without any other procedure. RESULTS A total of 2628 patients were included. The mean age was 59 years, mostly male (84.97%; n = 2233). Most patients underwent elective surgery (93.07%; n = 2446) and only 1.67% (n = 44) of the patients has high EuroSCORE category. Death was found in 4.22% (n-111) patients. EuroSCORE II had fair discriminant power (AUC 0.72), but a lower mortality predicted value for each group. CONCLUSION The parameters in EuroSCORE II are related with mortality in isolated CABG patients, but they cannot be used as mortality predictors in Indonesia.
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Affiliation(s)
- Rita Zahara
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | | | - Bambang Widyantoro
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Sugisman
- Department of Thoracic, Cardiac and Vascular Surgery Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Bagus Herlambang
- Department of Thoracic, Cardiac and Vascular Surgery Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Behnoush AH, Khalaji A, Rezaee M, Momtahen S, Mansourian S, Bagheri J, Masoudkabir F, Hosseini K. Machine learning-based prediction of 1-year mortality in hypertensive patients undergoing coronary revascularization surgery. Clin Cardiol 2023; 46:269-278. [PMID: 36588391 PMCID: PMC10018097 DOI: 10.1002/clc.23963] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Machine learning (ML) has shown promising results in all fields of medicine, including preventive cardiology. Hypertensive patients are at higher risk of mortality after coronary artery bypass graft (CABG) surgery; thus, we aimed to design and evaluate five ML models to predict 1-year mortality among hypertensive patients who underwent CABG. HYOTHESIS ML algorithms can significantly improve mortality prediction after CABG. METHODS Tehran Heart Center's CABG data registry was used to extract several baseline and peri-procedural characteristics and mortality data. The best features were chosen using random forest (RF) feature selection algorithm. Five ML models were developed to predict 1-year mortality: logistic regression (LR), RF, artificial neural network (ANN), extreme gradient boosting (XGB), and naïve Bayes (NB). The area under the curve (AUC), sensitivity, and specificity were used to evaluate the models. RESULTS Among the 8,493 hypertensive patients who underwent CABG (mean age of 68.27 ± 9.27 years), 303 died in the first year. Eleven features were selected as the best predictors, among which total ventilation hours and ejection fraction were the leading ones. LR showed the best prediction ability with an AUC of 0.82, while the least AUC was for the NB model (0.79). Among the subgroups, the highest AUC for LR model was for two age range groups (50-59 and 80-89 years), overweight, diabetic, and smoker subgroups of hypertensive patients. CONCLUSIONS All ML models had excellent performance in predicting 1-year mortality among CABG hypertension patients, while LR was the best regarding AUC. These models can help clinicians assess the risk of mortality in specific subgroups at higher risk (such as hypertensive ones).
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Affiliation(s)
- Amir Hossein Behnoush
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- School of MedicineTehran University of Medical SciencesTehranIran
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Amirmohammad Khalaji
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- School of MedicineTehran University of Medical SciencesTehranIran
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Malihe Rezaee
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
- School of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Shahram Momtahen
- Department of Surgery, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Soheil Mansourian
- Department of Surgery, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Jamshid Bagheri
- Department of Surgery, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Farzad Masoudkabir
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
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Chen S, Li J, Li Q, Qiu Z, Wu X, Chen L. Metabolic syndrome increases operative mortality in patients with impaired left ventricular systolic function who undergo coronary artery bypass grafting: a retrospective observational study. BMC Cardiovasc Disord 2019; 19:25. [PMID: 30674287 PMCID: PMC6343347 DOI: 10.1186/s12872-019-1004-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/14/2019] [Indexed: 12/04/2022] Open
Abstract
Background Metabolic syndrome (MetS) is a prevalent risk factor for coronary artery disease progression. Past studies have shown that MetS and its components tends to increase mortality after coronary artery bypass grafting (CABG), but data on the impact of MetS on postoperative outcome in patients with a left ventricular (LV) ejection fraction (EF) < 50% are still lacking. Methods Out of 2300 patients who underwent CABG between 2008 and 2018 in our center, 190 patients were identified as having impaired LV systolic function (EF < 50%). The patients were divided into two groups: those with MetS (n = 87, 45.8%) and those without MetS (n = 103, 54.2%). The influence of MetS on postoperative mortality and major complications was investigated. Results Postoperative mortality occurred in 12.6% of patients with MetS and in 3.9% of patients without MetS (p < 0.05). Multivariate analysis showed that patients with MetS had a significantly greater risk of mortality compared with patients without MetS (relative risk 7.23, p < 0.05). After adjustment for other risk factors, the risk of mortality was increased 6.47-fold [95% confidence interval (CI):1.25–33.6; p < 0.05] in patients with MetS and diabetes and 5.4-fold (95% CI: 1.12–29.7; p < 0.05) in patients with MetS and without diabetes, whereas it was not significantly increased in patients with diabetes and without MetS. Conclusions MetS is an important predictor of increased mortality in patients with LVEF<50% who undergo CABG. The components of MetS have synergistic effect in postoperative mortality. Multifactorial intervention in MetS is required to improve surgical efficacy in these patients.
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Affiliation(s)
- Shuangkun Chen
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Jiahui Li
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Qianzhen Li
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Zhihuang Qiu
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Xijie Wu
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Liangwan Chen
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China.
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Gianchandani RY, Esfandiari NH, Haft JW, Prager RL, Pop-Busui R. Diabetes and stress hyperglycemia in the intensive care unit: outcomes after cardiac surgery. Hosp Pract (1995) 2014; 40:22-30. [PMID: 22615075 DOI: 10.3810/hp.2012.04.966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Hyperglycemia is common in the post-cardiac surgery population and has been associated with increased mortality rates, surgical length of stay, and infection rates. Although hospitalized patients with diabetes are known to have more complications, recent studies in various hospital settings have reported worse outcomes in patients with stress hyperglycemia than in those with diabetes. AIM The primary objective of this study was to analyze 30- and 90-day mortality rates in post-cardiac surgery patients with stress hyperglycemia and diabetes who were managed to achieve similar moderate blood glucose goals using the University of Michigan Hospital (Ann Arbor, MI) insulin protocol between 2005 and 2008. The secondary outcomes were rates of postoperative complications, including hypoglycemia. METHODS A standardized glucose management program was followed to treat all patients in the cardiac intensive care unit, with a blood glucose goal of 100 to 140 mg/dL. Data from 1973 patients with either diabetes or stress hyperglycemia were analyzed to identify associations between mean postoperative blood glucose levels and mortality, incidence of hypoglycemia, and complication rates. RESULTS Mortality rates did not differ between patients with diabetes and stress hyperglycemia (3.4 and 2.3%; P = 0.2). Rates of severe hypoglycemia were low (1%) for both groups and were not associated with an increase in mortality (P = 0.95). Other complication rates were similar between patients with diabetes and stress hyperglycemia. CONCLUSION Maintaining a blood glucose range between 100 to 140 mg/dL in post-cardiac surgery patients was associated with a low mortality rate, low risk of hypoglycemia, and with complications rates that were similar in patients with diabetes and stress hyperglycemia.
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Affiliation(s)
- Roma Y Gianchandani
- Assistant Professor, Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI.
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van der Linden J, Bergman P, Hadjinikolaou L. The topography of aortic atherosclerosis enhances its precision as a predictor of stroke. Ann Thorac Surg 2007; 83:2087-92. [PMID: 17532403 DOI: 10.1016/j.athoracsur.2007.02.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Revised: 02/06/2007] [Accepted: 02/07/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Atherosclerosis of the thoracic aorta is an independent risk factor for stroke after cardiac surgery. No attention had so far been paid to its topography. The relationship between the topography of aortic atherosclerosis and stroke was studied in patients admitted for coronary surgery. METHODS The extent and location of atherosclerosis in the ascending aorta and arch was assessed intraoperatively with epiaortic ultrasound and transesophageal echocardiography in 611 consecutive patients. They were followed for 5.5 +/- 1.7 years (mean +/- SE), amounting to 3,358 patient-years. RESULTS The incidence of early postoperative (<30-day) stroke was 6.4% in patients with atherosclerosis of the ascending aorta and 1.5% in those without (p = 0.004). The five-year stroke-free survival rates (>30 days after the operation) for patients without aortic disease, with less than 50%, and with greater than 50% of the ascending aorta affected, were 95.3 +/- 0.9%, 91.8 +/- 2.1%, and 65.0 +/- 14.6%, respectively (p < 0.0001). CONCLUSIONS Atherosclerosis of the ascending aorta stands out as a predictor of late stroke. High risk is predominantly linked to atheromas in its distal part and lesser curvature.
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Affiliation(s)
- Jan van der Linden
- Karolinska Institute, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden.
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Völzke H, Kleine V, Robinson DM, Grimm R, Hertwig S, Schwahn C, Eckel L, Rettig R. Renin-angiotensin system and haemostasis gene polymorphisms and outcome after coronary artery bypass graft surgery. Int J Cardiol 2006; 98:133-9. [PMID: 15676177 DOI: 10.1016/j.ijcard.2004.03.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2003] [Accepted: 03/05/2004] [Indexed: 11/30/2022]
Abstract
BACKGROUND Coronary artery bypass graft surgery is associated with a considerable 2-year mortality rate. Gene polymorphisms of the renin-angiotensin system may be associated with the risk of hypertension and cardiovascular disease. The angiotensin I-converting enzyme DD genotype has recently been identified as independent predictor of the outcome after coronary artery bypass graft surgery. Genetic factors of the clotting system may be related to the risk of myocardial infarction and restenosis after coronary interventions. The aims of the present study were to investigate whether gene polymorphisms of the renin-angiotensin system (angiotensinogen 235 M/T, angiotensin II type 1 receptor 1166 A/C) or the clotting system (glycoprotein IIIa PlA1/PlA2 and factor V Leiden 1691 G/A) are associated with the outcome after coronary artery bypass grafting. METHODS A study population of 247 patients was followed-up 2 years after coronary artery bypass graft surgery. The primary end-point was total mortality. The secondary end-point was mortality from cardiac cause or the need for myocardial revascularization (percutaneous coronary interventions or recurrent surgery) during follow-up. Geno typing was performed by polymerase chain reaction- and restriction fragment length polymorphism-based techniques. RESULTS An older age and the non-use of the internal mammary artery graft were identified as independent predictors of the primary end-point after coronary artery bypass grafting. A decreased left ventricular ejection fraction was an independent predictor for the secondary end-point. No association was found between any of the genetic factors and the outcomes after coronary artery bypass graft surgery in the main factor regression models. However, the angiotensin II type 1 receptor 1166 A/C gene polymorphism modulated the effects of age on the primary end-point, and the angiotensinogen 235 M/T gene polymorphism modulated the effects of age on the secondary end-point. CONCLUSION We conclude that there are interactions between the angiotensin II type 1 receptor 1166 A/C as well as the angiotensinogen 235 M/T gene polymorphism and age with respect to the outcome after coronary artery bypass graft surgery. The glycoprotein IIIa PlA1/PlA2 and the factor V Leiden 1691 G/A gene polymorphisms were not associated with mid-term mortality or cardiac morbidity after coronary artery bypass grafting.
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Affiliation(s)
- Henry Völzke
- Department of Epidemiology and Social Medicine, Ernst Moritz Arndt University, Walther Rathenau Str. 48, D-17487 Greifswald, Germany.
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Ganushchak YM, Fransen EJ, Visser C, De Jong DS, Maessen JG. Neurological Complications After Coronary Artery Bypass Grafting Related to the Performance of Cardiopulmonary Bypass. Chest 2004; 125:2196-205. [PMID: 15189942 DOI: 10.1378/chest.125.6.2196] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Neurologic disorders belong among the most serious complications of cardiac surgery. We tested the hypothesis that combinations of hemodynamic events from apparently normal cardiopulmonary bypass (CPB) procedures are related to the development of postoperative neurologic complications and affect the impact of common clinical risk factors. DESIGN Retrospective study. SETTING Cardiothoracic surgery department in a university hospital. METHODS AND PATIENTS A multivariate statistical procedure (ie, cluster analysis) was applied to a data set of automatically recorded perfusions from 1,395 patients who had undergone coronary artery bypass grafting. One-way analysis of variance was used to select five parameters with the strongest significant correlation to postoperative neurologic complications for further cluster analysis. The dependencies in the clusters were tested against common clinical risk factors. To our knowledge, this is the first study of its kind. RESULTS The following five parameters emerged for cluster analysis: mean arterial pressure (MAP); dispersion of MAP; dispersion of systemic vascular resistance; dispersion of arterial pulse pressure; and the maximum value of mixed venous saturation. Using these parameters, we found four clusters that were significantly different by CPB performance (first cluster, 389 patients; second cluster, 431 patients; third cluster; and fourth cluster, 229 patients). The frequency of postoperative neurologic complications was 0.3% in the first cluster and increased to 3.9% in the fourth cluster. Importantly, the impact of common clinical risk factors for postoperative neurologic complications was affected by the performance of the CPB procedure. For example, the frequency of neurologic complications among patients with cerebrovascular disease in their medical history was 22% in the fourth cluster, whereas it was zero in the second cluster. CONCLUSIONS This study shows that apparently normal CPB procedures affect the impact of common clinical risk factors on postoperative neurologic complications. Patients who underwent CPB procedures with large fluctuations in hemodynamic parameters particularly showed an increased risk for the development of postoperative neurologic complications.
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Affiliation(s)
- Youri M Ganushchak
- Department of Extra-Corporeal Circulation, University Hospital Maastricht, Maastricht, The Netherlands.
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Lindsay GM, Smith LN, Hanlon P, Wheatley DJ. The influence of general health status and social support on symptomatic outcome following coronary artery bypass grafting. Heart 2001; 85:80-6. [PMID: 11119470 PMCID: PMC1729595 DOI: 10.1136/heart.85.1.80] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To assess health status, level of social support, and presence of coronary artery disease risk factors before and after coronary artery bypass grafting (CABG); to assess symptomatic relief approximately 12 months postoperatively; and to examine the association between preoperative health status and recurrence of symptoms. DESIGN Observational study. SETTING Preoperatively, in hospital outpatient department (1995-1996); postoperatively, at home (1996-97). SUBJECTS AND METHODS Patients awaiting elective CABG were recruited one month before the expected date of operation. Preoperative assessment included severity of symptoms, coronary artery disease risk factors, short form 36 (SF-36) questionnaire, and social activities questionnaire. The presence and severity of angina and breathlessness were reported postoperatively (mean 16.4 months). Multiple regression analysis was used to identify factors associated with improved outcome following CABG. MAIN OUTCOME MEASURE Patient reported presence and severity of angina and breathlessness. RESULTS 183 patients were followed for a mean of 16. 4 months after CABG. Angina and breathlessness were completely relieved in 55% and 36% of patients, respectively. In patients with residual symptoms, the severity was significantly reduced (angina p < 0.001; breathlessness, p = 0.02). Patients with low SF-36 scores and low social network scores preoperatively were less likely to be relieved of symptoms (p < 0.001). Health status and social support levels preoperatively were lower than in other reported coronary artery disease patients groups. Preoperatively, coronary artery disease risk factors were higher than recommended in current guidelines: 67.4% had raised plasma cholesterol, 39.0% were hypertensive, 80% were moderately obese, and 22.9% were smokers. CONCLUSIONS Recurrence of symptoms exceeded other published studies. Patients' perception of general health, symptoms, and social support influences outcome.
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Affiliation(s)
- G M Lindsay
- Nursing and Midwifery School, University of Glasgow, 68 Oakfield Avenue, Glasgow G12 8LS, UK.
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Herlitz J, Brandrup-Wognsen G, Karlson BW, Sjöland H, Karlsson T, Caidahl K, Hartford M, Haglid M. Mortality, risk indicators, mode and place of death and symptoms of angina pectoris in the five years after coronary artery bypass grafting in patients with and without a history of hypertension. Blood Press 2000; 8:200-6. [PMID: 10697299 DOI: 10.1080/080370599439571] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AIM To describe mortality, risk indicators for death, place and mode of death, and symptoms of angina pectoris among survivors in the 5 years after coronary artery bypass grafting (CABG) in patients with and without a history of hypertension. METHODS All patients in western Sweden who underwent CABG without concomitant valve surgery and without previously performed CABG between June 1988 and June 1991. RESULTS A total of 1997 patients were included in the analysis, 740 (37%) of whom had a history of hypertension. Patients with no history had a 5-year mortality of 12.4%. The corresponding relative risk for hypertensives was 1.4 (95% CI 1.1-1.8). Risk factors for death appeared similar in patients with and without a history of hypertension. Patients with hypertension had an increased risk of death in hospital and an increased risk of a non-cardiac death. Among survivors after 5 years, patients with a history of hypertension tended to have a higher prevalence of symptoms equivalent to angina pectoris. CONCLUSIONS Patients with a history of hypertension have an increased risk of death in the 5 years after CABG. Risk factors for death appear similar in patients with and without a history of hypertension. Patients with hypertension have a particularly increased risk of death in hospital and of death judged as non-cardiac.
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Affiliation(s)
- J Herlitz
- Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden
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Brorson B, Herlitz J, Werkö L. Evaluation of patients referred for possible coronary revascularization among patients with and without a history of hypertension. Swedish Coronary Artery Revascularization/Swedish Council on Technology Assessment in Health Care (SECOR/SBU) Project Group. Blood Press 1999; 8:151-7. [PMID: 10595692 DOI: 10.1080/080370599439670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Patients with and without a history of hypertension referred for eventual coronary revascularization were compared on the basis of a national survey including previous history, indications for coronary angiography, use of medication, findings at exercise test and cardioangiography, and long-term prognosis. As part of a national study of the appropriateness of coronary revascularization, data were prospectively collected on patients referred for possible coronary revascularization to 7/8 public Swedish heart centers that performed approximately 92% of all bypass operations in Sweden in 1994. The study included 2764 patients of whom 986 (36%) had a history of hypertension. Indications for coronary angiography were similar in patients with and without a history of hypertension. Triple therapy (a combination of beta-blockers, long-acting nitrates and calcium channel-blockers) was more frequently used among patients with hypertension (32.6% as compared with 21.4% among patients without hypertension; p < 0.001). With the exception of ST depression > 6 min after discontinuation of exercise test, which was more frequent among hypertensive patients (30.9% vs 25.7%; p < 0.05), the various indicators of myocardial ischemia were similar in the two groups during exercise. Patients with hypertension had a somewhat lower exercise capacity (mean of 109.6 w) than patients without hypertension (113.7; p < 0.05). The extent of coronary artery disease was more severe among hypertensives (p < 0.001). Overall mortality during the subsequent 21 months was 5.6% for patients with hypertension and 3.1% for patients without hypertension (p < 0.01). This was caused mainly by a difference in cardiovascular mortality (3.9% vs 2.5%; p < 0.05) and cerebrovascular mortality (1.0% vs 0.3%; p < 0.05). Among patients referred for possible coronary revascularization, those with a history of hypertension differed from those without such a history, in that they more frequently had ST depression at exercise test, a lower exercise capacity, more severe coronary artery disease, a higher frequency of triple-therapy use and a higher mortality rate.
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Affiliation(s)
- B Brorson
- The Swedish Council on Technology Assessment in Health Care, Stockholm
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Sjöland H, Hartford M, Caidahl K, Karlson BW, Wiklund I, Karlsson T, Herlitz J. Improvement in various estimates of quality of life after coronary artery bypass grafting in patients with and without a history of hypertension. J Hypertens 1997; 15:1033-9. [PMID: 9321752 DOI: 10.1097/00004872-199715090-00015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To describe various estimates of the quality of life (QOL) prior to and for 2 years after coronary artery bypass grafting (CABG) for patients with a history of hypertension compared with nonhypertensives. METHODS Patients in western Sweden in whom CABG had been performed between 1988 and 1991 participated. Their QOL was estimated from the Physical Activity Score, the Nottingham Health Profile, and the Psychological General Well-being Index. RESULTS All three questionnaires detected a significant improvement in QOL already at 3 months, which persisted at 1 and 2 years both for hypertensive and for nonhypertensive patients. With the Physical Activity Score and the Psychological General Well-being Index the improvement in QOL of hypertension patients was less marked 3 months after the operation compared with that of nonhypertensives (P < 0.05). Two years after the CABG improvement was less marked for hypertensive patients than it was for nonhypertensive patients in terms of the Physical Activity Score (P < 0.01). With the Nottingham Health Profile the improvement was similar for hypertensive and nonhypertensive patients at each evaluation after the operation. With all three measures the results indicated that hypertensive patients had a worse QOL that did nonhypertensive patients. However, in a multivariate analysis considering other risk indicators simultaneously, a history of hypertension did not appear as an independent risk indicator for an adverse QOL 2 years after CABG. CONCLUSION There was a significant improvement in various QOL estimates after CABG both for hypertensive and for nonhypertensive patients. The degree of improvement tended to be less marked for hypertensive patients than it was for nonhypertensive patients, especially 3 months after the operation and concerning physical activities. Hypertensives had a worse QOL than did nonhypertensives. However, the differences were small and could mainly be explained in terms of factors other than hypertension.
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Affiliation(s)
- H Sjöland
- Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden
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