Determinants of the Downward Trend in Coronary Artery Bypass Graft Surgery Among Patients With Multivessel Disease and Class-I Indication for Surgery

Abstract

IntroductionCoronary artery bypass graft (CABG) is the most effective coronary revascularization procedure, and it has been endorsed by many trials and studies over the years. However, due to CABG's immediate adverse effects, patients tend to prefer percutaneous coronary intervention (PCI) for coronary revascularization over it. This article focuses on the recent downtrend in CABG procedures for revascularization among patients for whom it is indicated. This study's main objective was to identify the factors responsible for the downtrend in patients undergoing CABG despite a clear indication for it in those with multivessel diseases. MethodsThis study was conducted at the Lady Reading Hospital, Peshawar, Pakistan, from August 1, 2020, to January 1, 2021. A total of 340 patients with a class-I indication (presence of conditions regarding which there is evidence and/or general agreement that a given procedure or treatment is beneficial, useful, and effective) for CABG were enrolled in the study. Data related to all the variables were collected from patients and hospital records through an adequately designed proforma. For analysis, we applied the chi-square test to elaborate on the data for information and point biserial correlation to rule out the effect of age and weight on CABG's downward trend. ResultsThe mean age of the patients was 58.77 ± 9.54 years; 65.88% were male, and 34.12% were female. Only 17.65% of the patients underwent CABG; 71.47% opted for medical treatment, and 9.41% underwent PCI. Out of the 280 patients who did not undergo CABG, 26.76% had financial issues; 23.82% were high-risk patients and hence refused surgeries by the surgeons; 20.59% of patients were not willing to undergo surgery; 7.94% were on the waiting list, and 3.24% had deranged renal function tests (RFTs). ConclusionsA limited number of patients underwent revascularization therapy even though they had clear indications for CABG. The high-risk status of patients, patients' unwillingness, and the cost of the procedure were the primary reasons behind the downtrend in CABG procedures among patients with a clear indication for the same.

Pós-operatório domiciliar de cirurgia cardíaca: percepções de pacientes

“…No que diz respeito aos dados de caracterização encontrados no presente estudo, os resultados são diferentes de uma pesquisa no Paquistão com 340 pacientes, na qual a maioria era de mulheres, com idade superior a 60 anos e com prevalência de CC de RM (13) . Já um estudo brasileiro mostrou maior prevalência no sexo masculino, com 55,94% dos casos em relação a 44,06% do sexo feminino (14) .…”

7-year outcomes in diabetic patients after coronary artery bypass graft in a developing country

“…Moreover, the outcomes of CABG could have been influenced by various factors throughout the years, such as the administration of the left internal mammary artery (LIMA) versus Saphenous vein graft (SVG) or other grafts as the conduit [ 11 ]. Also, the growing tendency to undergo medical treatment or intervention instead of surgery led to a drop in surgical trends even among the indicated patients for CABG [ 12 ]. For instance, although, according to a study in the united states, the post-operative mortality of CABG has remained unchanged over the years, the patients undergoing surgery have become older and with more comorbid conditions such as diabetes [ 13 ].…”