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Published on: March 27, 2018
Low left ventricular ejection fraction, complication rescue, and long-term survival after coronary artery bypass
Shuab Omer1, Ademola Adeseye1, Ernesto Jimenez2
1Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
Insights
Low left ventricular ejection fraction (LVEF) increases complications after coronary artery bypass grafting (CABG). However, patients rescued from complications face worse long-term survival, irrespective of LVEF.
Area of Science:
- Cardiology
- Cardiac Surgery
- Outcomes Research
Background:
- Low left ventricular ejection fraction (LVEF) is a known risk factor for adverse outcomes following cardiac surgery.
- The impact of LVEF on long-term survival after isolated coronary artery bypass grafting (CABG), particularly in the context of perioperative complications, requires further elucidation.
Purpose of the Study:
- To evaluate the association between reduced LVEF, the occurrence of perioperative complications, and long-term survival after isolated CABG.
- To investigate whether complication rescue modifies the relationship between LVEF and long-term mortality.
Main Methods:
- A national cohort study utilizing data from the Veterans Affairs Surgical Quality Improvement Program (2000-2016).
- Patients undergoing isolated CABG were categorized by LVEF (<25%, 25%-34%, ≥35%) and complication status (none, 1, or >1).
- Multivariable Cox regression models were employed to assess the associations between LVEF, complications, and mortality risk.
Main Results:
- A total of 61,477 patients were analyzed. Decreasing LVEF was significantly associated with increased odds of perioperative complications.
- A dose-response relationship was observed between lower LVEF and increased long-term mortality risk.
- Patients rescued from complications experienced decreased 10-year survival, irrespective of their LVEF; this association was particularly pronounced following multiple complications, where LVEF lost its predictive value for mortality.
Conclusions:
- While reduced LVEF is linked to higher complication rates post-CABG, the long-term survival of patients rescued from complications is diminished, regardless of baseline LVEF.
- Emphasis on complication prevention and prompt management is crucial for improving quality of care.
- Further research is warranted to identify strategies for mitigating the long-term adverse survival impact of perioperative complications in CABG patients.
Objectives:
To evaluate the association between low left ventricular ejection fraction (LVEF), complication rescue, and long-term survival after isolated coronary artery bypass grafting.
Methods:
National cohort study of patients who underwent isolated coronary artery bypass grafting (2000-2016) using Veterans Affairs Surgical Quality Improvement Program data. Left ventricular ejection fraction was categorized as ≥35% (n = 55,877), 25%-34% (n = 3893), or <25% (n = 1707). Patients were also categorized as having had no complications, 1 complication, or more than 1 complication. The association between LVEF, complication rescue, and risk of death was evaluated with multivariable Cox regression.
Results:
Among 61,477 patients, 6586 (10.7%) had a perioperative complication and 2056 (3.3%) had multiple complications. Relative to LVEF ≥35%, decreasing ejection fraction was associated with greater odds of complications (25%-34%, odds ratio, 1.30 [1.18-1.42]; <25%, odds ratio, 1.65 [1.43-1.92]). There was a dose-response relationship between decreasing LVEF and overall risk of death (≥35% [ref]; 25%-35%, hazard ratio, 1.46 [1.37-1.55]; <25%, hazard ratio, 1.68 [1.58-1.79]). Among patients who were rescued from complications, there were decreases in 10-year survival, regardless of LVEF. Among those rescued after multiple complications, LVEF was no longer associated with risk of death.
Conclusions:
While decreasing LVEF is associated with post-coronary artery bypass grafting complications, patients rescued from complications have worse long-term survival, regardless of left ventricular function. Prevention and timely treatment of complications should remain a focus of quality improvement initiatives, and future work is needed to mitigate their long-term detrimental impact on survival.
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