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Published on: January 28, 2020
Long-term prognosis in patients with end-stage renal disease after coronary artery bypass grafting
Philip Y K Pang1, Christopher K J Teow2,3, Ming Jie Huang1
1Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore.
Insights
Coronary artery bypass grafting (CABG) in end-stage renal disease (ESRD) patients has high operative mortality and poor survival. Age, left ventricular ejection fraction, and non-elective surgery predict operative death, while age and NYHA class impact long-term survival.
Area of Science:
- Nephrology
- Cardiology
- Cardiovascular Surgery
Background:
- Cardiovascular disease (CVD) is a leading cause of death in end-stage renal disease (ESRD) patients.
- Coronary artery bypass grafting (CABG) can benefit selected ESRD patients.
- This study examines survival and prognostic factors for ESRD patients undergoing CABG.
Purpose of the Study:
- To investigate survival outcomes in ESRD patients after CABG.
- To identify prognostic factors for operative mortality and long-term survival in this population.
Main Methods:
- Retrospective analysis of 149 ESRD patients who underwent isolated CABG (2006-2015).
- Multivariable analysis for operative mortality predictors.
- Cox regression analysis for long-term survival factors.
Main Results:
- Operative mortality was 13.4%.
- 10-year survival was 19.2%.
- Predictors of operative mortality included age, low LVEF, and non-elective surgery. Age, NYHA class III/IV, and LIMA-LAD grafting influenced long-term survival.
Conclusions:
- CABG in ESRD patients is linked to high operative mortality and diminished long-term survival.
- Age and NYHA class are key determinants of late survival.
- Left internal mammary artery (LIMA) to left anterior descending artery (LIMA-LAD) grafting improves long-term survival.
Background:
Cardiovascular disease is a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Coronary artery bypass grafting (CABG) is beneficial in selected patients with ESRD. This study investigates the survival outcomes and prognostic factors in ESRD patients who underwent CABG.
Methods:
A retrospective analysis was performed for 149 patients with ESRD who underwent isolated CABG between 2006 and 2015.
Results:
Mean age was 59.4±8.7 years and 106 patients (71.1%) were male. Operative mortality occurred in 20 patients (13.4%). Overall survival was 81.1%±3.2% at 1 year, 41.5%±4.3% at 5 years and 19.2%±4.2% at 10 years. Median survival was 4.3 years. Multivariable analysis identified age [P=0.001, odds ratio (OR): 1.15 per 1-year increase, 95% confidence interval (CI): 1.06-1.25], preoperative left ventricular ejection fraction (LVEF) (P=0.020, OR: 0.94, 95% CI: 0.89-0.99) and non-elective status of operation (P=0.049, OR: 3.34, 95% CI: 1.00-11.1) as predictors of operative mortality. Cox regression analysis identified age [P<0.001, hazard ratio (HR): 1.05 per 1-year increase, 95% CI: 1.03-1.08], New York Heart Association (NYHA) class III or IV status (P=0.010, HR: 1.75, 95% CI: 1.15-2.67) and the use of a left internal mammary artery (LIMA) to left anterior descending artery (LIMA-LAD) graft (P=0.029, HR: 0.42, 95% CI: 0.19-0.92) as factors influencing long-term survival.
Conclusions:
CABG is associated with high operative mortality and poor long-term survival in ESRD patients. Age and NYHA class influenced late survival. LIMA-LAD grafting conferred a long-term survival advantage.
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