IJCS | Volume 32, Nº2, May/June 2019

220 Lobato et al. Patients undergoing cagb in Pará, Brazil Int J Cardiovasc Sci. 2019;32(3)217-226 Original Article Systemic arterial hypertension was the most common cardiovascular risk factor (83.2%), followed by active smoking at admission (57.5%) and diabetes mellitus (48;6%). The most common comorbidities were left ventricular contractile dysfunction (33.0%), chronic obstructive pulmonary disease (3.9%) and baseline chronic kidney disease (3.4%). A small proportion of patients had undergone any myocardial revascularization procedure. Less than half of patients were on medical therapy for coronary artery disease (Table 1). Most patients underwent elective surgeries. Mean extracorporeal circulation and anoxia time was 77.6 and 46.2 minutes, respectively. Mean time from admission to surgery was 23.4 days, and the length of stay at the intensive care unit and hospital stay was 10.5 days and 15.6 days, respectively (mean) (Table 2). A high incidence of hospital infection was found (52.5%), 16.2% during the admission-to-surgery period and 47.5% after surgery (Table 3); hospital-acquired respiratory tract infection was the most frequent (p = 0.003) (Figure 1). Other common postoperative complications during hospitalization were bleeding (37.4%), blood transfusion (37.4%), complex arrhythmias (21.8%) and acute renal injury requiring hemodialysis (4.5%) (Table 3). There was no case of perioperative myocardial infarction documented. Mortality rate was 11.7%; 85.7% of deaths (n = 18) occurred during hospital stay and 1.3% (n = 3) during the first year of follow-up. The most frequent cause of death was septic shock (57.1%) and cardiogenic shock (33.3%) (Table 4). Of patients discharged after MRS, 18.9% were lost to outpatient follow-up. Among the others, 24.5% had 1-2 outpatient visits, more than half of patients (56.6%) had 3 or more visits during the first year after surgery; 10.1% reported recurrence of stable angina, 1.5% stroke and 0.8% needed another revascularization procedure. Mortality-related factors were previous MRS, age ≥ 80 years (Figure 2), infection before or after surgery, baseline chronic kidney disease, renal failure requiring hemodialysis, previous MRS, prolonged hospital stay and patients waiting for surgery (Table 5). Discussion MRS is a therapeutic option for some CAD patients, aiming not only to increase patients’ survival but also to alleviate symptoms, especially angina. 14 Table 2 - Characteristics of myocardial revascularization surgeries of the patients who underwent the procedure at Fundação Hospital de Clínicas Gaspar Vianna between 2013 and 2014 Variable N % or mean ± SD 95%CI Lower limit Upper limit Year of surgery 2013 113 63.1 55.6 70.2 2014 66 36.9 29.8 44.4 Emergency of MRS Elective 165 92.2 87.2 95.7 Urgent 14 7.8 4.3 12.8 Time of ECC (minutes) 179 77.6 ± 28. 2 - - Time of anoxia (minutes) 179 46.2 ± 18.8 - - Time to surgery (days) 179 23.4 ± 15.9 - - Postoperative time (days) 179 15.6 ± 14.2 - - ICU stay (days) 179 10.5 ± 9.8 - - ECC: extracorporeal circulation; MRS: myocardial revascularization surgery; SD: standard deviation. ICU: intensive care unit.