Assessment of the comorbidity index in patients with ischemic heart disease before coronary artery bypass treatment

Abstract

The aim of the work: to determine the prevalence and establish the frequency of comorbidity in patients with ischemic heart disease when planning myocardial revascularization by performing coronary artery bypass grafting.

Materials and methods. The study included patients with ischemic heart disease who underwent coronary artery bypass grafting on a working heart (n = 3672), both male (n = 3059, 83,3 %) and female (n = 613, 16,7 %), the average age of the study participants was 61.1 ± 0.8 years. The study design consisted of dividing participants into four age groups according to the WHO classification. The material for the analysis was anamnestic and diagnostic and treatment data of 3672 electronic medical histories of patients with ischemic heart disease for the period from 2015 to 2021. All patients included in the study were under dispensary observation at the State Institution “National Institute of Cardiovascular Surgery named after M. M. Amosov NAMS of Ukraine” and at the municipal non-profit enterprise “Cherkasy Regional Cardiology Center of the Cherkasy Regional Council”. To standardize approaches to assessing comorbidity, the Charlson Comorbidity Index (CCI) and the Charlson Age-Augmented Comorbidity Index (CA-CCI) were determined, and a comprehensive assessment of comorbidity was compared with the results of coronary artery bypass grafting.

Results. The frequencies of the most common comorbidities in patients with ischemic heart disease on the eve of myocardial revascularization by coronary artery bypass grafting were determined. In accordance with the study design, taking into account the age of the patients, the frequencies of comorbidities included in the standard deficit of the calculation of the СCI were established. It was determined that the most common comorbidities with ischemic heart disease are: chronic heart failure – 84.0 %, myocardial infarction – 58.7 %, chronic kidney disease – 29.5 % and type 2 diabetes mellitus – 19.7 %. Statistical differences in the frequencies of the most common comorbidities were established taking into account the age of the patients. It was found that the highest CA-CCI was in patients of senile age – 6.8 and in elderly patients – 5.4.

Conclusions. It was determined that the average number of diseases per patient in this sample was 2.6 ± 0.3, and the variation series of the number of existing concomitant diseases ranged from 1 to 7 diseases. The determined average СCI was 3.1 ± 0.3, and the average age-associated СA-СCI was 4.6 ± 0.3, which must be taken into account when planning the method of myocardial revascularization due to the interaction of a separate pathology, which is exacerbated by the aggression of surgical trauma and causes a different spectrum of complications during surgical interventions, increasing perioperative mortality. A comprehensive assessment of the frequency of existing concomitant diseases in a cohort of patients with ischemic heart disease of a large center-based study on the eve of myocardial revascularization by calculating СCI and СA-СCI increases the objectivity of the choice of treatment tactics.