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Published on: March 27, 2018
Predictors of contemporary coronary artery bypass grafting outcomes
Richard D Weisel1, Nancy Nussmeier2, Mark F Newman3
1Division of Cardiac Surgery, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
Insights
Heart failure history and older age predict adverse outcomes after coronary artery bypass grafting (CABG). Aspirin use before CABG was protective, while longer cardiopulmonary bypass times increased risk.
Area of Science:
- Cardiovascular Surgery
- Clinical Trials
- Outcomes Research
Background:
- Coronary artery bypass grafting (CABG) patient risk profiles are increasing.
- Despite this, morbidity and mortality rates remain low.
- Identifying current predictors of adverse outcomes is crucial for developing new treatments.
Purpose of the Study:
- To identify predictors of adverse outcomes in patients undergoing CABG.
- To analyze baseline and intraoperative variables associated with poor outcomes.
Main Methods:
- Analysis of data from the Reduction in cardiovascular Events by acaDesine in patients undergoing CABG (RED-CABG) trial.
- Logistic regression modeling with stepwise variable selection to identify predictors.
- Inclusion of both prespecified baseline and intraoperative variables.
Main Results:
- Preoperative predictors of adverse outcomes included heart failure history (OR 2.9), increasing age (OR 1.033 per decade), and peripheral vascular disease (OR 1.6).
- Aspirin use prior to CABG demonstrated a protective effect (OR 0.5).
- Longer cardiopulmonary bypass duration (OR 1.8) was the sole intraoperative predictor of adverse events.
Conclusions:
- Patients with heart failure, including those with preserved systolic function, face high risks similar to those with low ejection fractions.
- Recognizing patients with significant atherosclerotic burden may guide perioperative interventions.
- Contemporary CABG risks have evolved, necessitating updated strategies for outcome improvement.
Objectives:
The study objective was to identify the predictors of outcomes in a contemporary cohort of patients from the Reduction in cardiovascular Events by acaDesine in patients undergoing CABG (RED-CABG) trial. Despite the increasing risk profile of patients who undergo coronary artery bypass grafting, morbidity and mortality have remained low, and identification of the current predictors of adverse outcomes may permit new treatments to further improve outcomes.
Methods:
The RED-CABG trial was a multicenter, randomized, double-blind, placebo-controlled study that determined that acadesine did not reduce adverse events in moderately high-risk patients undergoing nonemergency coronary artery bypass grafting. The primary efficacy end point was a composite of all-cause death, nonfatal stroke, or the need for mechanical support for severe left ventricular dysfunction through postoperative day 28. Logistic regression modeling with stepwise variable selection identified which prespecified baseline characteristics were associated with the primary outcome. A second logistic model included intraoperative variables as potential covariates.
Results:
The 4 independent preoperative risk factors predictive of the composite end point were (1) a history of heart failure (odds ratio, 2.9); (2) increasing age (odds ratio, 1.033 per decade); (3) a history of peripheral vascular disease (odds ratio, 1.6); and (4) receiving aspirin before coronary artery bypass grafting (odds ratio, 0.5), which was protective. The duration of the cardiopulmonary bypass (odds ratio, 1.8) was the only intraoperative variable that contributed to adverse outcomes.
Conclusions:
Patients who had heart failure and preserved systolic function had a similar high risk of adverse outcomes as those with low ejection fractions, and new approaches may mitigate this risk. Recognition of patients with excessive atherosclerotic burden may permit perioperative interventions to improve their outcomes. The contemporary risks of coronary artery bypass grafting have changed, and their identification may permit new methods to improve outcomes.
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