Consequences of coronary artery bypass grafting in smokers and addicts

Document Type : Original Article


1 Cardiovascular Surgeon, Faculty of Medicine, Mashhad University Of Medical Sciences, Mashhad, Iran.

2 Cardiovascular Surgeon, Faculty of Medicine ,Department Of Cardiovascular Surgery, Faculty Of Medicine, Mashhad University Of Medical Sciences, Mashhad, Iran

3 Student Research Committee, Faculty of Medicine, Islamic Azad University, Mashhad Branch, Mashhad, Iran.

4 Msc Student Of Biostatistics, Social Determinants Of Health Research Center, Mashhad University Of Medical Sciences, Mashhad, Iran.

5 Cardio Surgeon, Department of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction: The most common cardiac disease is coronary artery disease (CAD) in the world. Coronary artery bypass grafting (CABG) is implemented through two standard surgical techniques, namely off-pump beating-heart CABG (OPCABG) and on-pump CABG (ONCABG). The CABG results in various levels of morbidity, especially in smokers and addicts, who have a lower pain threshold. Regarding this, the aim of this study was to clarify several aspects of the consequences of CABG, especially in smokers and addicts.
Materials and Methods:
This cross-sectional study was conducted on 125 CABG candidates referring to the Cardiac Department of Ghaem Hospital in Mashhad, Iran, within 2014-2015. The patients underwent either OPCAB or ONCABG. The recorded data included the type and dosage of intra- and post-operative opioids used for the induction and maintenance of anaesthesia, as well as the volume of packed red blood cells, fresh frozen plasma, and platelet. Data analysed using IBM SPSS 19.0 and p-value less than 0.05 considered statistically significant.
Result: According to the results, the mean age of the patients were 59.4±9.8 years. Out of the 125 participants, 89 and 36 patients underwent ONCABG and OPCABG, 71.9% and 58.3% of whom were male, respectively. The sufentanil dose administered for the induction of anaesthesia was 9.9±2.7 cc in the smokers, which was significantly higher in comparison to the dose (7.3±2.1 cc) used for the non-smokers (P=0.015). Furthermore, the mean doses of dobutamine used for the addicted and non-addiced patients were 4.4±1.8 and 5.5±2.2 cc, respectively, which was significantly different between the two groups (P=0.037).
 Conclusion: The ONCABG is a common surgical technique, which is used in patients with a more coronary vessel involvement. This study has demonstrated that although the same opioid anaesthetic drugs were used for the smokers and addicted patient, the dose of administered sufentanil was significant different between smokers and non-smokers.


1.            Pegg TJ, Selvanayagam JB, Francis JM, Karamitsos TD, Maunsell Z, Yu L-M, et al. A randomized trial of on-pump beating heart and conventional cardioplegic arrest in coronary artery bypass surgery patients with impaired left ventricular function using cardiac magnetic resonance imaging and biochemical markers. Circulation. 2008;118(21):2130-8.
2.            Cowie M, Mosterd A, Wood D, Deckers J, Poole-Wilson P, Sutton G, et al. The epidemiology of heart failure. European heart journal. 1997;18(2):208-25.
3.            McMurray JJ, Stewart S. Epidemiology, aetiology, and prognosis of heart failure. Heart. 2000;83(5):596-602.
4.            Cheng DC, Bainbridge D, Martin JE, Novick RJ. Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2005;102(1):188-203.
5.            Hernandez F, Cohn WE, Baribeau YR, Tryzelaar JF, Charlesworth DC, Clough RA, et al. In-hospital outcomes of off-pump versus on-pump coronary artery bypass procedures: a multicenter experience. The Annals of thoracic surgery. 2001;72(5):1528-34.
6.            Mohr FW, Morice M-C, Kappetein AP, Feldman TE, Ståhle E, Colombo A, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. The lancet. 2013;381(9867):629-38.
7.            Lamy A, Devereaux P, Prabhakaran D, Taggart DP, Hu S, Paolasso E, et al. Off-pump or on-pump coronary-artery bypass grafting at 30 days. New England Journal of Medicine. 2012;366(16):1489-97.
8.            Karbasy SH, Derakhshan P. Effects of opium addiction on level of sensory block in spinal anesthesia with bupivacaine for lower abdomen and limb surgery: a case-control study. Anesthesiology and pain medicine. 2014;4(5).
9.            Arom KV, Flavin TF, Emery RW, Kshettry VR, Janey PA, Petersen RJ. Safety and efficacy of off-pump coronary artery bypass grafting. The Annals of thoracic surgery. 2000;69(3):704-10.
10.          Kissin I. Opioid prescriptions for pain and epidemic of overdose death: can the dramatic reduction in anesthesia mortality serve as an example? Journal of pain research. 2016;9:453.
11.          Hu S, Li Q, Gao P, Xiong H, Zheng Z, Li L, et al. Simultaneous hybrid revascularization versus off-pump coronary artery bypass for multivessel coronary artery disease. The Annals of thoracic surgery. 2011;91(2):432-8.
12.          Hu S, Zheng Z, Yuan X, Wang W, Song Y, Sun H, et al. Increasing long-term major vascular events and resource consumption in patients receiving off-pump coronary artery bypass: a single-center prospective observational study. Circulation. 2010;121(16):1800-8.
13.          Palmer G, Herbert MA, Prince SL, Williams JL, Magee MJ, Brown P, et al. Coronary Artery Revascularization (CARE) registry: an observational study of on-pump and off-pump coronary artery revascularization. The Annals of thoracic surgery. 2007;83(3):986-92.
14.          Mukherjee D, Ashrafian H, Kourliouros A, Ahmed K, Darzi A, Athanasiou T. Intra-operative conversion is a cause of masked mortality in off-pump coronary artery bypass: a meta-analysis. European Journal of Cardio-Thoracic Surgery. 2012;41(2):291-9.
15.          Pagley PR, Beller GA, Watson DD, Gimple LW, Ragosta M. Improved outcome after coronary bypass surgery in patients with ischemic cardiomyopathy and residual myocardial viability. Circulation. 1997;96(3):793-800.
16.          Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N, Wolman R, et al. Adverse cerebral outcomes after coronary bypass surgery. New England Journal of Medicine. 1996;335(25):1857-64.
17.          van Dijk D, Nierich AP, Jansen EW, Nathoe HM, Suyker WJ, Diephuis JC, et al. Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study. Circulation. 2001;104(15):1761-6.
18.          Bruins P, te Velthuis H, Yazdanbakhsh AP, Jansen PG, Van Hardevelt FW, de Beaumont EM, et al. Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia. Circulation. 1997;96(10):3542-8.
19.          Ascione R, Lloyd CT, Underwood MJ, Lotto AA, Pitsis AA, Angelini GD. Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. The Annals of thoracic surgery. 2000;69(4):1198-204.
20.          Diegeler A, Hirsch R, Schneider F, Schilling L-O, Falk V, Rauch T, et al. Neuromonitoring and neurocognitive outcome in off-pump versus conventional coronary bypass operation. The Annals of thoracic surgery. 2000;69(4):1162-6.
21.          Hartman GS, Fun-sun FY, Bruefach M, Barbut D, Peterson JC, Charlson ME, et al. Severity of aortic atheromatous disease diagnosed by transesophageal echocardiography predicts stroke and other outcomes associated with coronary artery surgery: a prospective study. Anesthesia & Analgesia. 1996;83(4):701-8.
22.          Alderman EL, Fisher LD, Litwin P, Kaiser GC, Myers WO, Maynard C, et al. Results of coronary artery surgery in patients with poor left ventricular function (CASS). Circulation. 1983;68(4):785-95.
23.          Allman KC, Shaw LJ, Hachamovitch R, Udelson JE. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis. Journal of the American College of Cardiology. 2002;39(7):1151-8.
24.          Passamani E, Davis KB, Gillespie MJ, Killip T, Investigators CP, Associates* T. A randomized trial of coronary artery bypass surgery: survival of patients with a low ejection fraction. New England Journal of Medicine. 1985;312(26):1665-71.
25.          Di Carli MF, Maddahi J, Rokhsar S, Schelbert HR, Bianco-Batlles D, Brunken RC, et al. Long-term survival of patients with coronary artery disease and left ventricular dysfunction: implications for the role of myocardial viability assessment in management decisions. The Journal of Thoracic and Cardiovascular Surgery. 1998;116(6):997-1004.
26.          Scott SM, Deupree RH, Sharma G, Luchi RJ. VA Study of Unstable Angina. 10-year results show duration of surgical advantage for patients with impaired ejection fraction. Circulation. 1994;90(5 Pt 2):II120-3.
27.          Ueki C, Sakaguchi G, Akimoto T, Ohashi Y, Sato H. On-pump beating-heart technique is associated with lower morbidity and mortality following coronary artery bypass grafting: a meta-analysis. European Journal of Cardio-Thoracic Surgery. 2016;50(5):813-21.
28.          Masuda M, Kuwano H, Okumura M, Amano J, Arai H, Endo S, et al. Thoracic and cardiovascular surgery in Japan during 2012. General thoracic and cardiovascular surgery. 2014;62(12):734-64.
29.          Deshpande C, Mohite S, Kamdi P. Sufentanil vs fentanyl for fast-track cardiac anaesthesia. Indian journal of anaesthesia. 2009;53(4):455.
30.          Chiang H-L, Chia Y-Y, Lin H-S, Chen C-H. The implications of tobacco smoking on acute postoperative pain: a prospective observational study. Pain Research and Management. 2016;2016.