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Published on: March 27, 2018
Complexity of coronary artery disease affects outcome of patients undergoing coronary artery bypass grafting with
Giovanni Melina1, Emiliano Angeloni, Umberto Benedetto
1Department of Cardiac Surgery, Ospedale Sant'Andrea, Sapienza University, Rome, Italy. gmelina@ospedalesantandrea.it
Insights
The SYNTAX score effectively predicts long-term outcomes for patients with left ventricular dysfunction undergoing coronary artery bypass grafting, highlighting coronary artery disease complexity as a key prognostic factor.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Left ventricular dysfunction is a significant risk factor in patients undergoing coronary artery bypass grafting (CABG).
- Predicting outcomes in this high-risk population remains challenging.
- The SYNTAX score assesses coronary artery disease complexity, but its predictive value in patients with left ventricular dysfunction needs further evaluation.
Purpose of the Study:
- To evaluate the SYNTAX score's ability to predict mortality and major adverse cardiac and cerebrovascular events (MACCE) in patients with left ventricular dysfunction undergoing isolated CABG.
- To assess the correlation between SYNTAX score, left ventricular function improvement, and New York Heart Association (NYHA) functional class post-CABG.
Main Methods:
- A cohort of 191 patients with left ventricular ejection fraction ≤40% undergoing isolated CABG were stratified by SYNTAX score (low, intermediate, high).
- Outcomes assessed included all-cause mortality, MACCE, left ventricular ejection fraction, and NYHA functional class.
- Kaplan-Meier analysis and receiver operating characteristic (ROC) curve analysis were used to evaluate predictive performance.
Main Results:
- Higher SYNTAX scores were associated with significantly lower survival rates (P=.001) and increased MACCE (P=.002).
- The SYNTAX score demonstrated superior predictive power for late mortality compared to preoperative left ventricular ejection fraction and incomplete revascularization (AUC 0.70 vs 0.59 and 0.55, respectively).
- Patients with lower SYNTAX scores showed greater improvement in left ventricular ejection fraction and NYHA functional class.
Conclusions:
- Coronary artery disease complexity, as assessed by the SYNTAX score, is directly related to late outcomes in patients with left ventricular dysfunction undergoing CABG.
- The SYNTAX score is a valuable tool for predicting mortality in this patient group.
- Further research is warranted to validate these findings.
Objective:
To determine whether the SYNTAX score can predict the outcomes of patients with left ventricular dysfunction undergoing coronary artery bypass grafting.
Methods:
We studied a consecutive series of 191 patients (mean age, 67 ± 10 years) with a left ventricular ejection fraction of 40% or less who were undergoing isolated coronary artery bypass grafting. All patients were stratified according to their SYNTAX score, indicating coronary artery disease complexity: low, 0 to 22; intermediate, 23 to 32; and high, 33 or more. The primary outcome was all-cause mortality. Secondary outcomes included the late occurrence of major adverse cardiac and cerebrovascular events, left ventricular function, and New York Heart Association functional class.
Results:
The mean SYNTAX score was 32 ± 13, and the mean preoperative left ventricular ejection fraction was 35% ± 6%. At a median follow-up of 43 months, the primary outcome had occurred in 46 of 191 patients (24%). Kaplan-Meier analysis showed a survival of 81% ± 15% for low, 77% ± 7% for intermediate, and 53% ± 7% for high coronary artery disease complexity (χ(2), 29.4; P = .001). The rate of major adverse cardiac and cerebrovascular events was significantly greater in patients with a SYNTAX score of 33 or more (P = .002). Greater degrees of left ventricular ejection fraction improvement were found in patients with a SYNTAX score of 32 or less (+15% ± 10% vs +4% ± 11%; P = .17) and translated into a better New York Heart Association functional class among patients with a lower SYNTAX score (P = .01). Receiver operating characteristic curve analysis showed the SYNTAX score (area under the curve, 0.70; 95% confidence interval, 0.63-0.77) to have the best predictive power for late mortality with respect to the preoperative left ventricular ejection fraction (area under the curve, 0.59; difference, P = .04) and incomplete revascularization (area under the curve, 0.55; difference, P = .02).
Conclusions:
The results of the present study have shown a direct relationship between coronary artery disease complexity and late outcomes of patients with left ventricular dysfunction who are undergoing coronary artery bypass grafting. Additional studies are needed to confirm these findings.
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