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Published on: March 27, 2018
Preoperative ejection fraction as a predictor of survival after coronary artery bypass grafting: comparison with a
Mohamed A Soliman Hamad1, Albert H M van Straten, Jacques P A M Schönberger
1Department of Cardio-Thoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands. aasmsn@cze.nl
Insights
Preoperative ejection fraction impacts survival after coronary artery bypass grafting. Patients with ejection fraction below 50% experienced worse outcomes, while those above 50% showed improved long-term survival.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Statistics
Background:
- Preoperative left ventricular dysfunction is a known risk factor for mortality after revascularization.
- Ejection fraction (EF) is a key indicator of left ventricular function.
Purpose of the Study:
- To evaluate the effect of preoperative ejection fraction on short-term and long-term survival after coronary artery bypass grafting (CABG).
Main Methods:
- Retrospective analysis of 10,285 patients undergoing isolated CABG between 1998 and 2007.
- Patients were stratified into three groups based on preoperative ejection fraction.
- Survival rates were compared to age-, sex-, and year-matched general population data.
Main Results:
- Ejection fraction was identified as a significant predictor of early and late mortality.
- Patients with a preoperative ejection fraction < 50% had poorer long-term survival compared to expected survival.
- Patients with a preoperative ejection fraction > 50% demonstrated long-term survival exceeding expected survival.
Conclusions:
- The severity of left ventricular dysfunction, indicated by ejection fraction, is directly associated with patient survival post-CABG.
- A preoperative ejection fraction below 50% is linked to worse outcomes in CABG patients compared to the general population.
Background:
Preoperative left ventricular dysfunction is an established risk factor for early and late mortality after revascularization. This retrospective analysis demonstrates the effects of preoperative ejection fraction on the short-term and long-term survival of patients after coronary artery bypass grafting.
Methods:
Early and late mortality were determined retrospectively in 10 626 consecutive patients who underwent isolated coronary bypass between January 1998 and December 2007. The subjects were divided into 3 groups according to their preoperative ejection fraction. Expected survival was estimated by comparison with a general Dutch population group described in the database of the Dutch Central Bureau for Statistics. For each of our groups with a known preoperative ejection fraction, a general Dutch population group was matched for age, sex, and year of operation.
Results And Discussion:
One hundred twenty-two patients were lost to follow-up. In 219 patients, the preoperative ejection fraction could not be retrieved. In the remaining patients (n = 10 285), the results of multivariate logistic regression and Cox regression analysis identified the ejection fraction as a predictor of early and late mortality. When we compared long-term survival and expected survival, we found a relatively poorer outcome in all subjects with an ejection fraction of < 50%. In subjects with a preoperative ejection fraction of > 50%, long-term survival exceeded expected survival.
Conclusions:
The severity of left ventricular dysfunction was associated with poor survival. Compared with the survival of the matched general population, our coronary bypass patients had a worse outcome only if their preoperative ejection fraction was < 50%.
