c  2008 Wiley Periodicals, Inc. 275 Effect of Different Preoperative Patient Characteristics on Coronary Surgery Outcome: A Comparative Study Between a Developing and a Developed Country Sameh Sayed, M.D.,‡ Stefan Fischer, M.D., * Matthias Karck, M.D., Ph.D.,† Ahmed Hassouna, M.D.,§ and Axel Haverich, M.D., Ph.D. * ∗ Division of Cardiothoracic and Vascular Surgery, Hannover Medical School, Hannover,Germany; †Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg,Germany; ‡Department of Cardiothoracic Surgery, Assiut University Hospital, Assiut, Egypt; and §Department of Cardiothoracic Surgery, Ain Shams University Hospital, Cairo, Egypt ABSTRACT Objectives: To evaluate the impact of the preoperative patient characteristics on the results of coronary surgery in a developing country compared with a developed country. Patients and Methods: Pre- operative risk factors for coronary artery disease (CAD) and intraoperative and immediate postoperative variables for coronary surgery were compared. Sixty patients were operated at Ain Shams University in Cairo (Egypt) between March and September 1999, compared with 60 patients operated at Hannover med- ical school (Germany) between March and September 2001. By using univariate analysis and multivariate logistic regression, model predictors for hospital mortality were determined. Results: Groups were com- parable regarding a majority of risk factors except age, diabetes, chronic obstructive pulmonary disease (COPD), and hypertension. Seventy percent of the Egyptian patients presented in New York Heart Associa- tion (NYHA) class III, whereas 50% of the German patients were in NYHA class II. Fifty percent of the German patients showed left ventricular ejection fraction (LVEF) >60%, whereas 52% of the Egyptian patients had LVEF between 40% and 59%. Diabetes (56.6%) and COPD (43.3%) are the major predictors of hospital mortality among the Egyptian patients as proved by high odds ratio (4.6 and 3.4, respectively). Egyptian patients required prolonged mechanical ventilation and extended intensive care unit and hospital stay. Hospital mortality was 6.7% in the Egyptian versus 1.7% in the German group. Conclusion: Diabetes mel- litus, COPD, and prolonged mechanical ventilation are the major predictors of hospital mortality in Egypt. This study tries to underline problems of coronary artery bypass graft surgery in different populations. doi: 10.1111/j.1540-8191.2008.00717.x (J Card Surg 2009;24:275-280) Coronary artery disease (CAD) is the leading cause of cardiovascular mortality worldwide. 1 In 1990, it was found that 58% of the global CAD occurred in the de- veloping world, 2 with more than 4.5 million deaths in these countries. 3 In spite of lack of data on both CAD incidence and prevalence in developing countries, how- ever, reports have documented CAD incidence rates to be as high as 98 per 100,000 in China, 199 per 100,000 in India, and 166 per 100,000 in the Middle Eastern countries. 4 Address for correspondence: Sameh Abd El-Rahman M. Sayed, M.D., Prince Salman Heart Centre, King Fahad Medical City, P.O. Box 59046, Riyadh 11525, Saudi Arabia. Fax: +966 1 228 9999, ext. 1112; e-mail: samsayed@mailcity.com This work was presented in the the 24th Cardiovascular Surgical Sym- posium for the European Academy of Cardiac Surgery in Z ¨ urs , Austria, March 3 to 11, 2006. In the developing world, demographics and lifestyle changes are resulting in an epidemiological transition from prenatal and infectious diseases to noncommuni- cable disease such as CAD. 5 However, identifications of the risk factors for CAD, namely diabetes, genet- ics, hypercholesterolemia, hypertension, and smoking, have led to successful preventive efforts in industrial- ized nations; in contrast, exposure to these factors in developing nations appears to be increasing via global- ization of a dietary habits. 6 Coronary artery bypass grafting (CABG) has become a common surgical procedure in the management of CAD worldwide. While coronary revascularization is considered to be a routine operation in some centers of the world, CABG surgery is still attended with a lot of difficulties in other centers. Some of these difficulties may be related to the preoperative patient characteris- tics such as high incidence of diabetes and smoking.