The arrival of COVID-19 in Brazil and the impact on coronary artery bypass surgery.

Mejia, Omar A V; Borgomoni, Gabrielle B; Silveira, Lucas M V; Guerreiro, Gustavo P; Falcão Filho, Alexandre T G; Goncharov, Maxim; Dallan, Luís R P; Oliveira, Marco A P; de Sousa, Alexandre G; Nakazone, Marcelo A; Tiveron, Marcos G; Campagnucci, Valquíria P; de Barros E Silva, Pedro G M; Dallan, Luís A O; Lisboa, Luiz A F; Jatene, Fábio B

BACKGROUND AND AIM OF THE STUDY This study analyzed the arrival of coronavirus disease 2019 (COVID-19) in Brazil and its impact on coronary artery bypass grafting (CABG) surgery. METHODS Patients undergoing isolated CABG in six hospitals in Brazil were divided into two periods: pre-COVID-19 (March-May 2019, N = 468) and COVID-19 era (March-May 2020, N = 182). Perioperative data were included on a dedicated REDCap platform. Patients with clinical and tomographic criteria and/or PCR (+) for severe acute respiratory syndrome coronavirus 2 infection were considered COVID-19 (+). Logistic regression analysis was performed to create a multiple predictive model for mortality after CABG in COVID-19 era. RESULTS Compared to 2019, in 2020, CABG surgeries had a 2.8-fold increased mortality risk (95% confidence interval [CI]: 1-7.6, p = .041), patients who evolved with COVID-19 had a 11-fold increased mortality risk (95% CI: 2.2-54.9, p < .003), rates of morbidities and readmission to the intensive care unit. The surgical volume was decreased by 60%. The model to predict mortality after CABG in the COVID-19 era was validated with good calibration (Hosmer-Lemeshow = 1.43) and discrimination (receiver operating characteristic = 0.78). CONCLUSION The COVID-19 pandemic had an adverse impact on mortality, morbidity and volume of patients undergoing CABG.