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Outcomes of coronary artery bypass grafting in patients with heart failure with a midrange ejection fraction

Salil V Deo1, Varun Sundaram2, Jayakumar Sahadevan2

  • 1Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio; Cleveland VA CV Research Group, Cleveland, Ohio.

The Journal of Thoracic and Cardiovascular Surgery
|February 23, 2021
PubMed

Insights

Coronary artery bypass grafting (CABG) in patients with heart failure with midrange ejection fraction (HFmrEF) is associated with increased mortality and higher rates of myocardial infarction and heart failure hospitalization. These findings highlight the importance of considering ejection fraction in surgical outcomes.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Heart Failure Research

Background:

  • Coronary artery bypass grafting (CABG) is known to improve survival in patients with heart failure and severely reduced left ventricular ejection fraction (LVEF).
  • However, limited data exist on adverse cardiovascular event rates following CABG in patients with heart failure with midrange ejection fraction (HFmrEF), defined as LVEF >40% and <55%.

Purpose of the Study:

  • To investigate the impact of HFmrEF on outcomes after isolated CABG.
  • To compare adverse cardiovascular event rates, including all-cause mortality and heart failure hospitalizations, between patients with HFmrEF, reduced LVEF (HFrEF), and normal LVEF.

Main Methods:

  • Analysis of isolated CABG patient data from the Veterans Affairs national database (2010-2019).
  • Stratification of patients into control (normal LVEF, no heart failure), HFmrEF, and HFrEF groups.
  • Comparison of all-cause mortality using Cox models and heart failure hospitalization rates using recurrent events analysis.

Main Results:

  • The study included 6533 veterans: 4252 (65.1%) in the control group, 1715 (26.3%) with HFmrEF, and 566 (8.6%) with HFrEF.
  • Both HFmrEF and HFrEF groups showed a higher risk of death compared to the control group (HR 1.3 and 1.5, respectively).
  • HFmrEF patients had a higher risk of myocardial infarction (subdistribution HR 1.2) and significantly higher rates of heart failure hospitalization (HR 4.1) compared to controls.

Conclusions:

  • Heart failure with midrange ejection fraction negatively impacts survival following CABG.
  • Patients with HFmrEF also experience increased rates of myocardial infarction and heart failure hospitalizations after CABG.
  • These findings underscore the clinical significance of HFmrEF in the context of CABG surgery.
Abstract

Keywords:
coronary artery bypass graftingcoronary artery diseaseejection fractionheart failuresurvival

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