RESUMEN
The review contains data on rates of permanent loss of working ability (disability) after coronary artery bypass grafting (CABG) in Russia and in European populations of patients with ischemic heart disease. According to domestic studies determination of disability status is not based on assessment of objective characteristics of functional reserve of cardiovascular system. Most patients after surgery retain disability status. CABG is not a rehabilitating factor but on the contrary results in increase of number of officially disabled people.
Asunto(s)
Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Evaluación de la Discapacidad , Anciano , Enfermedad de la Arteria Coronaria/psicología , Humanos , Federación de Rusia , Resultado del TratamientoRESUMEN
UNLABELLED: Although excessive body mass and obesity are considered risk factors of a number of diseases and conditions numerous results of studies evidence for the existence of the "obesity paradox"--higher long-term survival of overweight and obese patients. Aim of this study was to elucidate impact of body mass index (BMI) on postoperative mortality and long-term survival of patients after coronary artery bypass grafting (CABG). MATERIAL AND METHODS: The study was conducted on the basis of register of patients with ischemic heart disease who had undergone CABG with or without correction of valvular defects and/or resection of left ventricular (LV) aneurism during the period from 2000 to 2009 in the Chelyabinsk Interregional Cardiosurgical Center. Duration of follow-up was 1 to 10 years (mean--2.3 ± 2.4 years). The patients were divided into groups in dependence on BMI. Multifactorial logistic regression analysis of association of BMI and hospital mortality was carried out with adjustment for age, sex, arterial pressure, presence of diabetes mellitus (DM), chronic obstructive pulmonary disease, LV aneurism, LV ejection fraction, and character of involvement of vessels. Long term survival was studied using Cox's regression model. RESULTS: Compared with group of patients with normal BMI DM and arterial hypertension were more often registered among patients with excessive body mass and obesity. Elevated body mass was not an independent factor of risk of postoperative and lower long-term survival. There was a tendency to lower survival among patients with BMI > 35 rg/m2. CONCLUSION: Results of this study evidence for the absence of proof of negative impact of excessive BMI on hospital mortality and long term survival.
Asunto(s)
Puente de Arteria Coronaria/mortalidad , Isquemia Miocárdica/cirugía , Obesidad/complicaciones , Complicaciones Posoperatorias/epidemiología , Sistema de Registros , Medición de Riesgo/métodos , Índice de Masa Corporal , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria/tendencias , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/mortalidad , Obesidad/epidemiología , Pronóstico , Estudios Retrospectivos , Federación de Rusia/epidemiología , Tasa de Supervivencia/tendencias , Factores de TiempoRESUMEN
Although excessive body mass and obesity are considered risk factors of a number of diseases and conditions numerous results of studies evidence for the existence of the "obesity paradox" - higher long-term survival of overweight and obese patients. Aim of this study was to elucidate impact of body mass index (BMI) on postoperative mortality and long-term survival of patients after coronary artery bypass grafting (CABG). MATERIAL AND METHODS: The study was conducted on the basis of register of patients with ischemic heart disease who had undergone CABG with or without correction of valvular defects and/or resection of left ventricular (LV) aneurism during the period from 2000 to 2009 in the Chelyabinsk Interregional Cardiosurgical Center. Duration of follow-up was 1 to 10 years (mean - 2.3+/-2.4 years). The patients were divided into groups in dependence on BMI. Multifactorial logistic regression analysis of association of BMI and hospital mortality was carried out with adjustment for age, sex, arterial pressure, presence of diabetes mellitus (DM), chronic obstructive pulmonary disease, LV aneurism, LV ejection fraction, and character of involvement of vessels. Long term survival was studied using Coxs regression model. RESULTS: Compared with group of patients with normal BMI DM and arterial hypertension were more often registered among patients with excessive body mass and obesity. Elevated body mass was not an independent factor of risk of postoperative and lower long-term survival. There was a tendency to lower survival among patients with BMI >35 rg/m2. CONCLUSION: Results of this study evidence for the absence of proof of negative impact of excessive BMI on hospital mortality and long term survival.
RESUMEN
This retrospective study was focused on the survival and working ability in 2169 men (mean age 54.5 +/- 5.8 yr) included in the registry after they underwent coronary bypass surgery in 2000-2009. Three, five and ten-year survival rates were 91, 87 and 74% respectively. Independent factors influencing long-term survival were correction of valve defects (OR 3, 1, 95%, CI 1.9-4.8; p < 0.001) and left ventricular ejection fraction (OR 2, 9, 95% CI 2.1-3.8; p < 0.001). 34.2 and 60.2% of the patients were disabled before and after surgery respectively. This rise is attributed to the poorly developed system of postoperative rehabilitation. Occupational status was not an independent factor affecting long-term survival.