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National Analysis of Coronary Artery Bypass Grafting in Autoimmune Connective Tissue Disease
Esteban Aguayo1, Vishal Dobaria2, Sohail Sareh2
1Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
Insights
Coronary artery bypass graft (CABG) surgery in patients with autoimmune connective tissue diseases (CTDs) shows favorable outcomes, with reduced complications and costs. However, patients with antiphospholipid syndrome (APLS) require careful consideration due to increased risks.
Area of Science:
- Cardiology
- Rheumatology
- Health Services Research
Background:
- Autoimmune connective tissue diseases (CTDs) are linked to accelerated atherosclerosis and inflammation, often necessitating immunosuppression.
- Large-scale outcomes of coronary artery bypass graft (CABG) surgery in CTD patients remain underreported.
- This study investigates CABG utilization trends and clinical outcomes in patients with CTDs.
Purpose of the Study:
- To characterize trends in CABG use among patients diagnosed with CTDs.
- To evaluate the impact of CTDs on mortality, in-hospital complications, length of stay, and costs following CABG.
- To identify specific CTD subtypes that may influence surgical outcomes.
Main Methods:
- Utilized the 2005-2015 National Inpatient Sample to identify adult patients undergoing isolated CABG.
- Defined the CTDs cohort, including rheumatoid arthritis, lupus erythematosus, and antiphospholipid syndrome (APLS).
- Employed hierarchical multivariable logistic models to assess the independent impact of CTDs on clinical outcomes and healthcare costs.
Main Results:
- Out of 2,101,591 patients, 1.8% had CTDs; CABG use increased proportionally in this group.
- CTDs were not associated with increased mortality but showed protective effects against cardiovascular, neurologic, and infectious complications.
- CABG in CTD patients was linked to shorter hospital stays and reduced costs, except for APLS patients who faced higher mortality and complication rates.
Conclusions:
- CABG surgery in patients with CTDs demonstrates acceptable outcomes and paradoxically improved resource utilization.
- The findings suggest CABG is a viable option for CTD patients, offering clinical and economic benefits.
- CABG in patients with APLS warrants cautious evaluation due to associated inferior outcomes and increased complication risks.
Background:
Autoimmune connective tissue diseases (CTDs) are associated with accelerated atherosclerosis and inflammation, while often requiring immunosuppression. Large-scale outcomes of coronary artery bypass graft (CABG) surgery in this population have not been reported thus far. This study characterized trends in use of CABG in patients with CTDs and the impact of the disease on mortality, in-hospital complications, length of stay, and costs.
Methods:
The 2005 to 2015 National Inpatient Sample was used to identify all adult patients undergoing isolated CABG. The CTDs cohort included rheumatoid arthritis, lupus erythematosus, and antiphospholipid syndrome (APLS), among others. Hierarchical multivariable logistic models were used to calculate the independent impact of CTDs on clinical outcomes and costs.
Results:
Of an estimated 2,101,591 patients, 41,567 (1.8%) were diagnosed with CTDs (rheumatoid arthritis, 58%; systemic lupus erythematosus, 12%; APLS, 11%) Although the overall annual use of CABG decreased, the proportion of patients with CTDs receiving the operation significantly increased. After adjusting for patient and hospital characteristics, CTDs were not associated with increased mortality (adjusted odds ratio [AOR], 0.91; P = .34) but were protective against cardiovascular (AOR, 0.92; P < .003), neurologic (AOR, 0.81; P = .01), and infectious (AOR, 0.80; P = .01) complications. The diagnosis of CTDs was also predictive of reduced length of hospital stay (β-coefficient = -0.40; P < .001) and costs (β-coefficient, -$1200; P = .01). On subgroup analysis patients with APLS had significantly increased odds of mortality (AOR, 1.5) and increased renal (AOR, 1.3), infectious (AOR, 1.7), and thromboembolic (AOR, 4.3) complications (all P < .05).
Conclusions:
CABG in patients with CTDs provides acceptable outcomes and paradoxically improved resource use. However CABG in patients with APLS warrants careful consideration given inferior outcomes.
