Prediction of complications after coronary artery bypass grafting in patients with obesity
Authors:
Company:
1 Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation
2 Pirogov Russian National Research Medical University, Moscow, Russian Federation
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Type: Original articles
DOI:
For citation: Yakhyaeva K.B., Keren M.A., Sigaev I.Yu., Volkovskaya I.V., Mamalyga M.L., Zavalikhina T.V., Gelashvili D.G., Kosmacheva E.A. Prediction of complications after coronary artery bypass grafting in patients with obesity. Creative Cardiology. 2026; 20 (2): 221–233 (in Russ.). DOI: 10.24022/1997-3187-2026-20-2-221-233
Received / Accepted: 02.02.2026 / 11.03.2026
Keywords: coronary artery disease obesity coronary artery bypass grafting acute renal failure glomerular filtration rate Cockcroft–Gault creatinine clearance
Abstract
Objective. To analyze the incidence of 30-day complications after coronary artery bypass grafting (CABG) in obese patients and to evaluate the potential for predicting postoperative complications using various equations for assessing renal function.
Material and methods. The retrospective study included 836 patients with coronary artery disease who underwent CABG from 2018 to 2019. Five observation groups were formed: 1) patients with normal body weight (body mass index (BMI) 18.5–24.9 kg/m2, n = 151); 2) overweight (BMI 25–29.9 kg/m2, n = 328); 3) with obesity grade I (BMI 30–34.9 kg/m2, n = 266); 4) with obesity grade II (35–39.9 kg/m2, n = 60); 5) with obesity grade III (BMI ≥40 kg/m2, n = 31). The endpoint of the study was death from any cause that occurred within 30 days after CABG. Additionally, postoperative complications were assessed: non-fatal myocardial infarction, non-fatal acute cerebrovascular accident, acute heart failure, life-threatening cardiac arrhythmias and conduction disturbances, acute kidney failure, multiple organ failure, respiratory failure, and infectious complications. To assess renal function, creatinine clearance was calculated using the Cockcroft– Gault method, and glomerular filtration rate (GFR) was calculated using the MDRD and CKD-EPI (2021) formulas.
Results. When analyzing the immediate postoperative outcomes, a U-shaped relationship between BMI and the onset of death was determined. The result of a multifactorial analysis showed that in patients with overweight (MT), the relative risk of death after CABG was 6.7 times lower (HR 0.148; 95% CI 0.030–0.743, p = 0.020), and in patients with grade 1 obesity, the risk of death was 5.3 times lower (HR 0.183; 95% CI 0.036–0.919, p = 0.039) in comparison with patients with normal body weight. When assessing other postoperative complications, no significant differences were found between the groups, except for the frequency of acute renal failure. The presence of obesity with a BMI ≥31.17 kg/m2 increases the relative risk of acute renal failure after CABG by 4.77 times (HR 4.770, 95% CI 1.028–17.104; p = 0.044). In obese patients, the effectiveness of predicting adverse outcomes using the formula for assessing renal function CKD-EPI, 2021 (AUC 0.649, p = 0.008) is higher compared to other formulas (MDRD (AUC 0.626, p = 0.025) and Cockcroft–Gault creatinine clearance (AUC 0.606, p = 0.060)).
Conclusion. Patients with overweight and obesity I grade have the lowest risk of 30-day death. The risk of acute renal failure increases regardless of the severity of obesity. In patients with a BMI >30 kg/m2, the effectiveness of predicting adverse outcomes using the formula for assessing renal function CKD-EPI (2021) is higher compared to other formulas.
