Outcomes of On-pump Coronary Artery Bypass Grafting in Patients with Metabolic Syndrome in Mashhad, Iran

Document Type: Original Article

Authors

1 Atherosclerosis Prevention Research Center, cardiac surgery Imam Reza Hospital, Mashhad University of Medical Sciences,

2 Assistant professor, Department of cardiac surgery, Atherosclerosis Prevention Research Center ,Faculty of medical science, Mashhad University of Medical Sciences, Iran

3 Assistant Professor of Community Medicine, Faculty of medical science, Imam Reza Clinical Research Units, Mashhad University of Medical Sciences

4 Student Research Committee, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran

5 - Student Research Committee, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad,

6 Veterinary student.mashhad Ferdowsi scenice university

7 Assistant professor, Department of cardiac surgery, Faculty of medical science. Hamadan University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction: Metabolic syndrome (MS) is considered as an important risk factor for advanced coronary artery disease. This condition can increase the mortality and morbidity in the patients undergoing coronary artery bypass graft (CABG) surgery. The aim of the study was compared mortality and morbidity after off Pump- CABG surgery between patients with and without the Metabolic syndrome.
Materials & Methods: This prospective cross-sectional study was conducted on 120 patients, who underwent off-pump CABG surgery between October 2014-October 2016. The participants were equally divided into two groups including the patients with and without MS (MS and non-MS, respectively).
Results: According to the results, 68 (56.6%) patients were male. Furthermore, out of the 60 participants with MS, 36 (60%) cases were male. The mean ages of the MS and non-MS groups were 64.96±9.6 and 65.62±10.6 P=0.6 years, respectively. No statistically significant difference was observed between the two groups in terms of the mortality and morbidity (e.g., surgical wound infection, length of Intensive Care Unit and hospital stay, atrial fibrillation rhythm, and bleeding in the first 24 h). The intubation time in patients with Metabolic Syndrome was significantly higher than patients without Metabolic Syndrome (6.66 ± 1.97 vs 5.83 ± 1.93 respectively; P=0.007)
Conclusion: Metabolic syndrome was not associated with higher mortality and morbidity after CABG surgery compare to patients without Metabolic syndrome, although patients with Metabolic syndrome had higher risk for long intubation time.

Keywords


  1. Bruce KD, Byrne CD. The metabolic syndrome: common origins of a multifactorial disorder. Postgrad Med J. 2009; 85:614-21.
  2. Santos AC, Lopes C, Guimaraes JT, Barros H. Central obesity as a major determinant of increased high-sensitivity C-reactive protein in metabolic syndrome. Int J Obes. 2005; 29:1452-6.
  3. Swart MJ, De Jager WH, Kemp JT, Nel PJ, Van Staden SL, Joubert G. The effect of the metabolic syndrome on the risk and outcome of coronary artery bypass graft surgery. Cardiovasc J Afr. 2012; 23:400-4.
  4. Lorenzo C, Williams K, Hunt KJ, Haffner SM. The national cholesterol education program–adult treatment panel III, international diabetes federation, and world health organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes. Diabetes Care. 2007; 30:8-13.
  5. Alberti KG, Zimmet P, Shaw J; IDF Epidemiology Task Force Consensus Group. The metabolic syndrome--a new worldwide definition. Lancet. 2005; 366:1059-62.
  6. Zimmet P, Alberti G, Shaw J. A new IDF worldwide definition of the metabolic syndrome: the rationale and the results. Diabetes Voice. 2005; 50:31.
  7. Thomas GN, Ho SY, Janus ED, Lam KS, Hedley AJ, Lam TH, et al. The US national cholesterol education programme adult treatment panel III (NCEP ATP III) prevalence of the metabolic syndrome in a Chinese population. Diabetes Res Clin Pract. 2005; 67:251-7.
  8. Sirdah MM, Abu Ghali AS, Al Laham NA. The reliability of the National Cholesterol Education Program's Adult Treatment Panel III (NCEP/ATP III) and the International Diabetes Federation (IDF) definitions in diagnosing metabolic syndrome (MetS) among Gaz Strip Palestinians. Diabetes Metab Syndr. 2012; 6:4-8.
  9. Hassanin N, Gharib S, El Ramly MZ, Meged MA, Makram A. Metabolic syndrome and coronary artery disease in young Egyptians presenting with acute coronary syndrome. Kasr Al Ainy Med J. 2015; 21:27.
  10. Ranjith N, Pegoraro R, Naidoo DP, Esterhuizen TM. Metabolic syndrome in young Asian Indian patients with myocardial infarction. Cardiovasc J Afr. 2007; 18:228-33.
  11. Franco OH, Massaro JM, Civil J, Cobain MR, O'Malley B, D'Agostino RB Sr. Trajectories of entering the metabolic syndrome: the framingham heart study. Circulation. 2009; 120:1943-50.
  12. Malik S, Wong ND, Franklin SS, Kamath TV, Gilbert J, Pio JR, et al. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation. 2004; 110:1245-50.
  13. Shroyer AL, Coombs LP, Peterson ED, Eiken MC, DeLong ER, Chen A, et al. The society of thoracic surgeons: 30-day operative mortality and morbidity risk models. Ann Thorac Surg. 2003; 75:1856-64.
  14. Echahidi N, Pibarot P, Després JP, Daigle JM, Mohty D, Voisine P, et al. Metabolic syndrome increases operative mortality in patients undergoing coronary artery bypass grafting surgery. J Am Coll Cardiol. 2007; 50:843-51.
  15. Brackbill ML, Sytsma CS, Sykes K. Perioperative outcomes of coronary artery bypass grafting: effects of metabolic syndrome and patient’s sex. Am J Crit Care. 2009; 18(5):468-73.
  16. Sawant A, Mankeshwar R, Shah S, Raghavan R, Dhongde G, Raje H, et al. Prevalence of metabolic syndrome in urban India. Cholesterol. 2011; 2011:920983.
  17. Chow CK, Naidu S, Raju K, Raju R, Joshi R, Sullivan D, et al. Significant lipid, adiposity and metabolic abnormalities amongst 4535 Indians from a developing region of rural Andhra Pradesh. Atherosclerosis. 2008; 196:943-52.
  18. Simmons RK, Alberti KG, Gale EA, Colagiuri S, Tuomilehto J, Qiao Q, et al. The metabolic syndrome: useful concept or clinical tool? Report of a WHO Expert Consultation. Diabetologia. 2010; 53:600-5.
  19. van Straten AH, Bramer S, Soliman Hamad MA, van Zundert AA, Martens EJ, Schönberger JP, et al. Effect of body mass index on early and late mortality after coronary artery bypass grafting. Ann Thorac Surg. 2010; 89:30-7.
  20. Jones RH, Hannan EL, Hammermeister KE, DeLong ER, O'Connor GT, Luepker RV, et al. Identification of preoperative variables needed for risk adjustment of short-term mortality after coronary artery bypass graft surgery. The working group panel on the cooperative CABG database project. J Am Coll Cardiol. 1996; 28:1478-87.
  21. Birkmeyer NJ, Charlesworth DC, Hernandez F, Leavitt BJ, Marrin CA, Morton JR, et al. Obesity and risk of adverse outcomes associated with coronary artery bypass surgery. Northern New England Cardiovascular Disease Study Group. Circulation. 1998; 97:1689-94.
  22. Koochemeshki V, Amestejani M, Salmanzadeh HR, Ardabili SS. The effect of obesity on mortality and morbidity after isolated coronary artery bypass grafting surgery. Hypertension. 2012; 37:46-50.
  23. Reeves BC, Ascione R, Chamberlain MH, Angelini GD. Effect of body mass index on early outcomes in patients undergoing coronary artery bypass surgery. J Am Coll Cardiol. 2003; 42:668-76.
  24. Oreopoulos A, Padwal R, Norris CM, Mullen JC, Pretorius V, Kalantar‐Zadeh K. Effect of obesity on short‐ and long‐term mortality postcoronary revascularization: a meta‐analysis. Obesity. 2008; 16:442-50.
  25. Tie HT, Shi R, Li ZH, Zhang M, Zhang C, Wu QC. Risk of major adverse cardiovascular events in patients with metabolic syndrome after revascularization: a meta- analysis of eighteen cohorts with 18457 patients. Metabolism. 2015; 64:1224-34.
  26. Ardeshiri M, Faritus Z, Ojaghi-Haghighi Z, Bakhshandeh H, Kargar F, Aghili R. Impact of metabolic syndrome on mortality and morbidity after coronary artery bypass grafting surgery. Res Cardiovasc Med. 2014; 3:e20270.