Objectives: To examine causes of death and to find
predictors of hospital mortality after elective coronary artery bypass
graft (CABG) surgery.
Design: Case-control study.
Setting: Tertiary teaching hospital.
Methods: We prospectively collected various preoperative,
operative, and immediate postoperative variables in a cohort of
patients undergoing elective CABG surgery.
the 2,014 consecutive patients (mean [± SD] age of 61.3 ± 6.7
years old) undergoing elective CABG over a 2-year period, 27 patients
(1.3%) died during their hospitalization. The main causes of death
(either isolated or in combination) were cardiogenic shock (n = 13),
brain death or stroke (n = 7), septic shock (n = 4), ARDS
(n = 2), and pulmonary embolism (n = 1). A univariate statistical
analysis revealed factors that significantly correlate with outcome:
patient age, preoperative left ventricular ejection fraction, bypass
time, aortic cross-clamp time, number of blood units transfused, number
of inotropic agents administered in the operating room during the first
postoperative day (POD), history of arterial hypertension, intra-aortic
balloon pump usage, and perioperative development of shock. A logistic
regression analysis showed that the combination of the number of
inotropes and the number of blood units administered in the operating
room during POD 1 was the most important determinant of outcome, with
an overall positive predictive value of 91.7%.
Conclusions: We conclude that the analysis of simple
variables enhances our ability to accurately predict hospital mortality
in patients undergoing elective CABG surgery. The number of inotropic
agents and blood transfusions administered during the immediate
postoperative period is the most important independent predictor of