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Decreasing significance of left ventricular dysfunction and reoperative surgery in predicting coronary artery bypass
Piroze M Davierwala1, Manjula Maganti, Terrence M Yau
1Division of Cardiocascular Surgery, Yoronto General Hospital, University Health Network, Department of Surgery, and the Heart/Stroke Foundation/Richard Lewar Centre for Excellence, University of Toronto, Ontario, Canada.
Insights
Despite sicker patients, improved care has reduced mortality predictors in coronary artery bypass grafting (CABG). However, emergency surgery remains a significant risk factor for in-hospital death.
Area of Science:
- Cardiovascular Surgery
- Medical Outcomes Research
- Health Services Research
Background:
- Coronary artery bypass grafting (CABG) patients are increasingly older with greater comorbidity.
- Understanding evolving risk factors for in-hospital mortality is crucial for optimizing CABG outcomes.
Purpose of the Study:
- To evaluate changes in predictors of in-hospital mortality among patients undergoing CABG over a 12-year period.
- To assess the impact of time on patient risk profiles and surgical outcomes in CABG.
Main Methods:
- Prospective data collection on demographics, preoperative risk factors, operative variables, and outcomes for isolated CABG patients from 1990-2001.
- Patients divided into three groups based on operation year (1990-1993, 1994-1997, 1998-2001) to analyze temporal trends.
Main Results:
- In-hospital mortality for CABG decreased from 2.4% to 1.2% over 12 years.
- Severe left ventricular dysfunction and reoperative CABG became less significant predictors of mortality.
- Emergency surgery, though less frequent, carried an increasing odds ratio for mortality.
Conclusions:
- Improvements in perioperative management have mitigated the impact of certain risk factors like left ventricular dysfunction and reoperative CABG on in-hospital mortality.
- Emergency CABG remains a significant predictor of mortality, highlighting the need for continued focus on timely interventions.
Objectives:
Patients undergoing coronary artery bypass grafting are older and have greater comorbidity than those operated on previously. We evaluated the changes in the predictors of in-hospital mortality among patients undergoing coronary artery bypass grafting during the last 12 years.
Methods:
Data on demographic characteristics, preoperative risk factors, operative variables, and hospital outcomes were collected prospectively for all patients undergoing isolated coronary artery bypass grafting at a single institution from January 1, 1990, to December 31, 2001. To examine the effect of time on patient risk profiles and outcomes, we divided patients into three groups according to year of operation (1990-1993 n = 5171, 1994-1997 n = 5977, 1998-2001 n = 6893).
Results:
In-hospital mortality declined from 2.4% (1990-1993) to 1.2% (1998-2001, P <.0001). Left ventricular dysfunction, increasing age, female gender, hypertension, diabetes, cardiogenic shock, congestive heart failure, peripheral vascular disease, reoperative coronary artery bypass grafting, left main disease, and urgent surgery independently predicted in-hospital mortality in the entire cohort of 18,041 patients. Severe left ventricular dysfunction was the most significant predictor of in-hospital mortality in the 12-year cohort, but it had a declining influence with time (1990-1993 odds ratio 7.1, 1994-1997 odds ratio 5.1, 1998-2001 not statistically significant) because of improving outcomes. Reoperative coronary artery bypass grafting similarly decreased in significance as a predictor of mortality. Emergency coronary artery bypass grafting was performed less frequently in recent years, but the requirement for emergency surgery carried an increasing odds ratio for mortality.
Conclusions:
Despite increasing patient age and comorbidity, improvements in perioperative management have reduced the significance of severe left ventricular dysfunction and reoperative coronary artery bypass grafting but not emergency surgery as predictors of in-hospital mortality.
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