1. Introduction

Coronary heart disease (CHD) remains one of the leading causes of mortality and morbidity worldwide, with acute forms of CHD, such as unstable angina and acute myocardial infarction (MI), being critical conditions requiring urgent intervention. Coronary artery bypass grafting (CABG) surgery is a well-established procedure used to treat severe cases of CHD, particularly when revascularization via percutaneous coronary intervention (PCI) is not feasible or when there are multiple coronary artery blockages. CABG surgery aims to improve myocardial perfusion, reduce ischemic damage, and enhance patient survival by bypassing obstructed coronary arteries with grafts.

Despite the significant benefits of CABG, acute forms of CHD present unique challenges, including high-risk postoperative complications, prolonged recovery periods, and variations in patient outcomes. Early interventions after CABG surgery, including pharmacological therapy, monitoring, and management of comorbidities, play an essential role in optimizing recovery and minimizing adverse outcomes. This study investigates the results of interventions in patients with acute forms of CHD post-CABG surgery, focusing on their recovery, complications, and long-term health outcomes.

2. Materials and Methods

Study Design: This retrospective cohort study was conducted at the Republican Scientific Center for Emergency Medical Assistance, involving patients diagnosed with acute coronary heart disease who underwent coronary artery bypass grafting surgery between 2020 and 2022. The study aimed to evaluate the effect of different interventions on postoperative recovery and the clinical outcomes of these patients.

Participants: The study included 120 patients diagnosed with acute forms of CHD (unstable angina and acute myocardial infarction) who were scheduled for CABG surgery. All patients were aged between 40 and 75 years, with an average age of 59.4 years. Inclusion criteria included patients who had undergone elective or emergency CABG surgery, had no significant history of other chronic diseases (e.g., liver or kidney failure), and had provided informed consent. Exclusion criteria included patients with acute contraindications to surgery, such as active infections or terminal illnesses.

Data Collection: Preoperative and postoperative data were collected from patient medical records. Preoperative assessments included clinical presentation (e.g., symptoms, ECG findings, and biomarker levels such as troponin), comorbid conditions (e.g., diabetes mellitus, hypertension), and angiographic data showing the extent of coronary artery disease. Postoperative data were gathered at multiple time points (1 day, 7 days, and 30 days after surgery) to assess recovery, complications (e.g., infection, arrhythmias, graft failure), and overall outcomes.

Intervention Strategy: Patients received standardized interventions postoperatively, which included:

Pharmacological Management: Antiplatelet therapy (aspirin, clopidogrel), statins, beta-blockers, and angiotensin-converting enzyme inhibitors (ACE inhibitors) were administered according to standard clinical protocols.

Cardiac Monitoring: Continuous electrocardiogram (ECG) monitoring, assessment of hemodynamic stability, and use of inotropic support if necessary.

Rehabilitation Programs: Early mobilization and physical therapy, focusing on improving cardiovascular function and preventing complications like deep vein thrombosis (DVT) and pneumonia.

Nutritional Support: Tailored nutritional plans were implemented to promote healing and optimize energy intake during recovery.

Outcome Measures: The primary outcomes of this study were the postoperative mortality rate, incidence of major complications (e.g., myocardial infarction, stroke, infections), and improvements in myocardial perfusion as measured by follow-up imaging. Secondary outcomes included the length of hospital stay, readmission rates, and patient quality of life at 6-month and 12-month follow-ups. Statistical Analysis: Data were analyzed using SPSS version 26.0 software. Descriptive statistics were used to summarize patient demographics, clinical characteristics, and outcomes. Continuous variables were presented as mean ± standard deviation, while categorical variables were expressed as percentages. Comparisons between preoperative and postoperative outcomes were conducted using paired t-tests for continuous variables and chi-square tests for categorical variables.

3. Results and Discussions

A total of 120 patients diagnosed with acute forms of coronary heart disease (CHD), including unstable angina (UA) and acute myocardial infarction (AMI), underwent coronary artery bypass grafting (CABG) surgery at the Republican Scientific Center for Emergency Medical Assistance between 2020 and 2022. The mean age of the patients was 59.4 ± 9.2 years, with a male predominance (72%). The baseline clinical characteristics of the cohort, including risk factors such as hypertension (82%), diabetes mellitus (46%), and smoking (38%). [1]

Postoperative Outcomes:

Mortality Rate: The overall mortality rate in the first 30 days post-surgery was 3.5% (4 patients). Mortality was primarily attributed to complications such as postoperative myocardial infarction (MI) and multiple organ failure.

Major Complications: Of the 120 patients, 12 (10%) developed postoperative complications. These included:

Acute myocardial infarction (2.5%) in two patients, both of whom required reoperation.

Stroke (1.5%) in one patient, resulting in mild neurological impairment.

Graft failure (4%) in five patients, identified by post-operative angiography.

Infection (2.5%), with wound infections observed in three patients, all of whom were successfully treated with antibiotics.

Arrhythmias (2.5%), mainly atrial fibrillation, which was managed with rate control and antiarrhythmic therapy.

Myocardial Perfusion: Postoperative imaging (e.g., myocardial perfusion scintigraphy) revealed significant improvement in myocardial blood flow in the majority of patients, with 90% of patients showing marked improvement in coronary perfusion within 6 months post-surgery.

Hospital Stay: The mean length of hospital stay post-CABG was 12.5 ± 3.2 days. Patients who experienced complications had a longer hospital stay (mean: 18.4 ± 5.6 days) compared to those without complications (mean: 9.7 ± 2.4 days).

Recovery and Follow-up:

Quality of Life: At the 6-month follow-up, patients reported significant improvements in their quality of life, with 80% of patients showing increased functional capacity and reduced symptoms of angina.

Readmission Rates: The 6-month readmission rate was 15%, with the majority of readmissions due to non-cardiac reasons, such as respiratory infections and musculoskeletal pain.

This study highlights the outcomes of patients with acute coronary heart disease who underwent coronary artery bypass grafting (CABG) surgery. The findings underscore the significance of early intervention and optimized postoperative care in improving short-term recovery and long-term outcomes.

The mortality rate observed in this study (3.5%) is consistent with other large-scale studies involving high-risk patients undergoing CABG surgery. Previous studies have reported mortality rates in the range of 2-5% for high-risk patients with acute coronary syndromes, and our findings align with these results, indicating that CABG remains a life-saving intervention despite the severe nature of the disease.

Postoperative complications were relatively common in our cohort, with arrhythmias (particularly atrial fibrillation) being the most frequent complication. Atrial fibrillation following CABG is well-documented and is thought to result from the trauma of surgery, inflammation, and electrolyte imbalances. Early detection and management of these arrhythmias are essential, as they were effectively controlled in our patients with appropriate pharmacological treatment. [2]

The incidence of graft failure (4%) observed in our study is in line with the literature, which typically reports graft failure rates of 2-5% in the early postoperative period. This highlights the importance of continuous monitoring and follow-up to assess graft patency and myocardial perfusion. Advances in surgical techniques and graft materials, along with post-operative imaging, have made it possible to manage graft failure more effectively.

Importantly, myocardial perfusion was restored in the majority of patients, as evidenced by improved perfusion imaging studies. This reinforces the efficacy of CABG in enhancing myocardial oxygenation and preventing further ischemic damage. These results are consistent with other studies that show significant improvements in myocardial blood flow and clinical outcomes in patients undergoing CABG.

In terms of hospital stay, our findings reflect typical trends, with patients who experienced complications requiring longer stays in the hospital. This emphasizes the critical role of timely intervention and efficient postoperative care to minimize complications and shorten recovery times. Early mobilization, respiratory physiotherapy, and pharmacological management were key factors in promoting recovery and minimizing hospital-acquired complications.

The quality-of-life improvement observed in 80% of patients at the 6-month follow-up is encouraging. CABG not only improves survival rates but also significantly enhances patients' functional capacity, allowing them to resume normal activities and improve their overall well-being. This is in line with other studies that have demonstrated significant improvements in quality-of-life following CABG, with patients reporting reduced symptoms of angina and better physical endurance.

Despite the promising results, readmission rates remained a concern, particularly during the first 6 months post-surgery. The majority of readmissions were due to non-cardiac reasons, such as respiratory infections and musculoskeletal pain. This suggests that comprehensive rehabilitation programs focusing on both cardiac and non-cardiac recovery are crucial in preventing unnecessary hospitalizations and promoting long-term health. [3]

Limitations of the study include its retrospective design, which may introduce selection bias, and the relatively short follow-up period of 6 months. Future prospective studies with longer follow-up periods would provide more comprehensive insights into the long-term outcomes of CABG surgery in this patient population. [4]

In conclusion, our study confirms that CABG surgery is an effective treatment for patients with acute forms of coronary heart disease. Early postoperative interventions, careful monitoring, and rehabilitation strategies significantly contribute to reducing complications, improving myocardial perfusion, and enhancing overall patient recovery. However, attention must be paid to long-term follow-up and managing non-cardiac issues to further improve patient outcomes.

4. Conclusions

1. Efficacy of CABG Surgery: Coronary artery bypass grafting (CABG) is an effective surgical intervention for patients with acute forms of coronary heart disease, including unstable angina and acute myocardial infarction. The surgery significantly improves myocardial perfusion, reduces symptoms of angina, and enhances long-term survival rates.

2. Postoperative Recovery: While CABG is associated with a relatively low short-term mortality rate (3.5%) in high-risk patients, early postoperative complications such as arrhythmias, graft failure, and infections remain common. Effective postoperative care and monitoring are essential in minimizing these complications and optimizing recovery.

3. Improvement in Quality of Life: A significant improvement in the quality of life was observed in the majority of patients at the 6-month follow-up. Most patients showed increased functional capacity and fewer symptoms of angina, contributing to a better overall prognosis and enhanced physical well-being. [5]

4. Management of Complications: The study underlines the importance of proactive management of postoperative complications, including arrhythmias and graft failure. The timely intervention and close monitoring of graft patency are crucial in reducing the incidence of these complications.

5. Readmission and Rehabilitation: Although the readmission rate was relatively low, it remains a key factor influencing overall recovery. Non-cardiac reasons for readmission, such as infections and musculoskeletal pain, highlight the need for comprehensive rehabilitation programs that address both cardiac and non-cardiac recovery, reducing the likelihood of future hospitalizations.

6. Recommendations for Future Research: Longer-term follow-up studies with larger sample sizes are necessary to better understand the long-term outcomes and potential complications after CABG surgery. In addition, future research should focus on optimizing rehabilitation programs to improve both physical recovery and quality of life for post-CABG patients. [6]

In summary, CABG surgery remains a cornerstone of treatment for patients with acute coronary heart disease. The combination of effective surgical intervention, vigilant postoperative management, and rehabilitation can lead to favorable clinical outcomes and improved quality of life. Further research into optimizing patient care post-surgery is recommended to further enhance outcomes in this high-risk patient population.