Coronary artery bypass grafting in patients with low ejection fraction
Veli K Topkara1, Faisal H Cheema, Satish Kesavaramanujam
1Division of Cardiothoracic Surgery, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
Insights
Patients with low ejection fraction (EF) undergoing coronary artery bypass grafting (CABG) face higher risks. Despite increased mortality, CABG is a viable option for selected low EF patients, with improving outcomes over time.
Area of Science:
- Cardiology
- Cardiac Surgery
- Outcomes Research
Background:
- Low ejection fraction (EF) increases risks for patients undergoing cardiac surgery.
- Assessing the impact of reduced EF on clinical outcomes after coronary artery bypass grafting (CABG) is crucial.
Purpose of the Study:
- To evaluate the association between low ejection fraction (EF) and clinical outcomes in patients undergoing coronary artery bypass grafting (CABG).
Main Methods:
- Analysis of 55,515 patients who underwent CABG between 1997 and 1999 from the New York State database.
- Stratification into four ejection fraction (EF) groups: < or =20%, 21-30%, 31-40%, and >40% (Group IV).
- Comparison of postoperative complications, in-hospital mortality, and discharge destinations across EF groups.
Main Results:
- Patients with EF < or =20% (Group I) had higher rates of respiratory failure, renal failure, and sepsis compared to those with EF >40% (Group IV).
- In-hospital mortality was significantly higher in Group I (6.5%) versus Group IV (1.4%).
- Independent predictors of mortality in low EF patients included hepatic failure, renal failure, previous myocardial infarction, reoperation, emergent procedures, female gender, congestive heart failure, and age.
Conclusions:
- Patients with low EF are generally sicker and experience over four times higher mortality after CABG compared to those with high EF.
- Outcomes for CABG in low EF patients are improving and remain superior to historical data.
- Coronary artery bypass grafting (CABG) is a viable therapeutic option for carefully selected patients with low ejection fraction (EF).
Background:
Patients with low ejection fraction (EF) are at a higher risk for postoperative complications and mortality. Our objective was to assess the effect of low EF on clinical outcomes after coronary artery bypass grafting (CABG).
Methods And Results:
We analyzed 55,515 patients from New York State database who underwent CABG between 1997 and 1999. Patients were stratified into 1 of the 4 EF groups: Group I (EF< or =20%), Group II (EF 21% to 30%), Group III (EF 31% to 40%), and Group IV (EF>40%). History of previous myocardial infarction, renal failure, and congestive heart failure were higher in patients with low EF (all P<0.001). Group I experienced a higher incidence of postoperative respiratory failure (10.1% versus 2.9%), renal failure (2.5% versus 0.6%), and sepsis (2.5% versus 0.6%) compared with Group IV. In-hospital mortality was significantly higher in Group I (6.5% versus 1.4%; P<0.001). Multivariate analysis showed hepatic failure [odds ratio (OR), 11.2], renal failure (OR, 4.1), previous myocardial infarction (OR, 3.4), reoperation (OR, 3.4), emergent procedures (OR, 3.2), female gender (OR, 1.7), congestive heart failure (OR, 1.6), and age (OR, 1.04) as independent predictors of in-hospital mortality in the low EF group. The discharges to home rate were significantly lower in Group I versus Group IV (73.1% and 87.7%, respectively; P<0.001).
Conclusions:
Patients with low EF are sicker at baseline and have >4 times higher mortality than patients with high EF. However, outcomes are improving over time and are superior to historical data. Therefore, CABG remains a viable option in selected patients with low EF.
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