Higher Gensini Angiographic Score Predicts Poor Outcomes in High Weight Patients Undergoing Coronary Artery Bypass Grafting

However, the severity of coronary artery disease has not been clarified by using objective methods in the reports of obesity paradox. We believe that they have reached such a paradoxical finding as a result of operations in obese patients with relatively less risky coronary artery disease. Our purpose is to clarify whether angiographic severity (using Gensini score) affects early outcomes after coronary artery bypass grafting in high weight patients undergoing coronary artery bypass surgery. Material and Method: Clinical and angiographic data from a total of 126 patients with a body mass index of ≥ 30 kg/m2 undergoing isolated coronary artery bypass grafting were included. Primary outcome of interest was postoperative occurrence of early low cardiac output syndrome. Angiographic score of each patient was calculated according to the method described by Gensini. Factors associated with primary outcome were evaluated using multivariate analysis. Results: Low cardiac output syndrome occurred in 27 patients (21.4%). In multivariate analysis cross clamp time (OR: 1.064, 95% CI 1.026-1.103, p:0.001), age (OR: 1.099, 95% CI 1.028-1.175, p:0.006) and Gensini score (OR: 1.025, 95% CI 1.006-1.044, p:0.008) were found to be independent predictors of low cardiac output syndrome after coronary artery bypass grafting. Conclusion: Overweight patients with higher Gensini angiographic scores more tend to have low cardiac output syndrome after CABG than those with lower scores. Protective effects of obesity against postoperative risks after coronary artery bypass grafting should be revisited.

Koroner Arter Bypass Greftleme Operasyonu Yapılan Fazla Kilolu Hastalarda, Operasyon Sonrası Kötü Sonuçların Yüksek Gensini Anjiografik Skor ile Tahmin Edilmesi

Amaç: Son zamanlarda literatürde obezite paradoksu konusu altında fazla kilolu hastaların koroner arter bypass cerrahisi sonrası, gelişen risklere karşı korunduğu ileri sürülmektedir. Ancak bu raporlarda koroner arter hastalığının ciddiyetinin objektif olarak tespit edilmediği ve nispeten daha az riskli koroner arter hastalığı bulunan obez bireylerdeki operasyonlar sonucunda böyle bir paradoks bulguya vardıkları inancındayız. Biz, koroner arter bypass cerrahisi geçiren fazla kilolu hastalarda, cerrahi sonrası erken dönem sonuçların anjiografik ciddiyet seviyesi (Gensini skorlama sistemi) ile belirtilmesini amaçladık. Gereç ve Yöntem: Yalnızca koroner arter bypass greftleme operasyonu geçiren, vücut kitle indeksi ≥ 30 kg/m2 (ortalama yaş 61.05±8.8 yıl, erkek/ kadın oranı: 92/34) olan toplam 126 hastanın anjiografik ve klinik verileri çalışmaya dahil edildi. Primer olarak araştırılan postoperatif sonuç, erken dönem düşük kardiyak debi ve bununla ilişkili olan faktörlerdi. Her hastanın angiografik skorlaması, Gensini tarafından tanımlanan skor sitemine göre yapıldı. Primer sonuç ile ilişkili faktörler multivaryant analiz ile değerlendirildi. Bulgular: Vücut kitle indeksi seviyeleri, 92 hastada 30-35 kg/m2, 25 hastada 35-40 kg/m2 ve 9 hastada 40 kg/m2’nin üzerinde idi. 27 hastada düşük kardiyak debi görüldü. Multivaryant analizde, kross klemp süresi (OR: 1.064, %95 CI 1.026-1.103, p:0.001), yaş (OR: 1.099, %95 CI 1.028-1.175, p :0.006) ve Gensini skoru (OR: 1.025, %95 CI 1.006-1.044, p :0.008) koroner arter bypass greftleme sonrası düşük kardiyak debi gelişiminde bağımsız prediktör faktörler olarak bulundu. Sonuç: Koroner arter bypass greftleme cerrahisi sonrasında, yüksek Gensini anjiografik skorlu fazla kilolu hastalar, düşük skorlu hastalara nazaran düşük kardiyak debi gelişimine daha eğilimlidirler. Koroner arter bypass greftleme operasyonu sonrası, gelişebilecek risklere karşı obezitenin koruyucu etkileri tekrar gözden geçirilmelidir.

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