Forewarned Is Forearmed: Predicting Macce After Ra-midcab Surgery
Jef Van Den Eynde1, Frederik Peeters1, Herbert De Praetere1, Mark Coosemans2, Nick Hiltrop3, Johan Bennett1, Steven Jacobs1, Wouter Oosterlinck1.
1University Hospitals of Leuven, Leuven, Belgium, 2UZ Turnhout, Turnhout, Belgium, 3AZ Groeninge, Kortrijk, Belgium.
Objective: Predictive models in coronary heart disease are essential for improving clinical decision making and subsequent patient outcomes. Up until now no research has been done in predicting major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing Robotically Assisted Minimally Invasive Direct Coronary Artery Bypass Grafting (RA-MIDCAB). The aim of this retrospective study was to gain insight into predictors of 1-year MACCE in RA-MIDCAB. Methods: Between July 2015 and June 2019, 249 patients underwent RA-MIDCAB surgery at the University Hospitals of Leuven. Pre-, intra-, and postoperative data were collected retrospectively. Univariate and multivariate logistic regression models for MACCE (a composite of MI, stroke, repeat revascularization, and mortality) were constructed. Results: In the first 249 patients undergoing RA-MIDCAB, 15 patients (6,02%) experienced MACCE within the first year after surgery. Univariate regression model revealed the following variables to be significant at predicting 1-year MACCE: age (OR 1.08, p=0.017), DM (0R 3.63, p= 0.017), unstable angina (OR 3.47, p= 0.035), previous cardiac surgery (OR 19.33, p= 0.040), LAD and Cx as target vessels (7.35, p= 0.029), and duration of surgery (OR 1.01, p= 0.042) (Table 1.). In the multivariate regression model, only diabetes mellitus (OR 3.73, p=0.043) and unstable angina (OR 4.22, p=0.041) remained significant predictors. Conclusion: Our retrospective analysis confirms the relevance of preoperative and perioperative variables in the prediction of 1-year MACCE after RA-MIDCAB. Especially in patients with diabetes mellitus and those presenting with unstable angina, additional caution is required to improve patient outcomes. Potentially, reducing the duration of surgery while increasing the amount of arterial anastomoses could further improve the 1-year MACCE rate.
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