Change in the clinical profile of patients referred for coronary artery bypass grafting from 2004 to 2008. Trends in a single-centre study.

BACKGROUND AND AIMS: The aim of this study is to describe the changes that occurred between 2004 and 2008 in the profile of patients referred for off-pump surgical treatment of coronary artery disease, by determining changes in their clinical characteristics, surgical procedures, and their results. METHODS AND
RESULTS: This study is a retrospective evaluation of 2827 consecutive patients treated in the units of the 1st Chair of Cardiology of the Medical University of Warsaw from 2004 to 2008. We identified and retrieved 133 preoperative, intraoperative, and postoperative parameters. The statistical analysis was performed on measurable data in the analysed subgroups, but the relationship between immeasurable data was also examined. Significant declines in duration of hospitalisation, systolic and diastolic blood pressure on admission, left ventricular ejection fraction, stable coronary disease on admission, relationship between venous and arterial conduits used as graft, and in-hospital infections were observed. Meanwhile, the prevalence of arterial hypertension, of chronic pulmonary diseases, smoke, neurological dysfunction, heart rate on admission, diagnosis of two- and three-vessel disease and acute coronary syndrome/unstable angina, additive and logistic EuroScore, and average number of postoperative days in intensive care unit increased. More operations were performed as urgent/emergency cases, with higher numbers of grafts - which were more often arterial - per patient. An increase of length of the operation, blood loss and need for transfusion were observed as well as increased need for reoperation for bleeding.
CONCLUSIONS: Patients referred for coronary artery surgery are becoming higher-risk patients with a greater number of comorbidities, and surgical techniques are becoming progressively more sophisticated.