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Long-term outcome of surgical revascularization in patients with reduced left ventricular ejection fraction-a
Helga B Brynjarsdottir1, Arni Johnsen1, Alexandra A Heimisdottir1
1Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.
Insights
Surgical revascularization offers good long-term outcomes for patients with reduced left ventricular ejection fraction (LVEF). However, survival remains significantly lower compared to those with normal LVEF, highlighting the importance of risk stratification.
Area of Science:
- Cardiology
- Cardiac Surgery
- Outcomes Research
Background:
- Surgical revascularization is a key treatment for advanced coronary artery disease with reduced left ventricular ejection fraction (LVEF).
- Long-term outcomes for this patient group are not fully understood.
- This study investigates long-term results in a nationwide cohort.
Purpose of the Study:
- To evaluate the long-term outcomes of patients with ischemic cardiomyopathy undergoing surgical revascularization.
- To compare outcomes between patients with reduced LVEF (≤35%) and normal LVEF (>35%).
Main Methods:
- Retrospective analysis of 2005 patients undergoing isolated coronary artery bypass grafting (2000-2016).
- Patients stratified by preoperative LVEF: ≤35% (n=146) vs. >35% (n=1859).
- Comparison of demographics, major adverse cardiac and cerebrovascular events, and survival rates with a median follow-up of 7.6 years.
Main Results:
- Patients with LVEF ≤35% had higher rates of diabetes, renal insufficiency, COPD, and prior myocardial infarction.
- Thirty-day mortality was significantly higher in the reduced LVEF group (8% vs. 2%, P<0.001).
- Overall survival was substantially lower at 1 and 5 years for the reduced LVEF group (e.g., 5-year survival 69% vs. 91%, P<0.001). Reduced LVEF was independently associated with inferior survival (aHR 2.0, P<0.001).
Conclusions:
- Coronary artery bypass grafting can yield favorable long-term outcomes even in patients with reduced LVEF.
- Despite potential benefits, patients with reduced LVEF experience significantly inferior long-term survival compared to those with normal ventricular function.
- Risk stratification and careful patient selection remain crucial for optimizing outcomes in this population.
Objectives:
Surgical revascularization is an established indication for patients with advanced coronary artery disease and reduced left ventricular ejection fraction (LVEF). Long-term outcomes for these patients are not well-defined. We studied the long-term outcomes of patients with ischaemic cardiomyopathy who underwent surgical revascularization in a well-defined nationwide cohort.
Materials And Methods:
A retrospective study on 2005 patients that underwent isolated coronary artery bypass grafting in Iceland between 2000 and 2016. Patients were categorized into two groups based on their preoperative LVEF; LVEF ≤35% (n = 146, median LVEF 30%) and LVEF >35% (n = 1859, median LVEF 60%). Demographics and major adverse cardiac and cerebrovascular events were compared between groups along with cardiac-specific and overall survival. The median follow-up was 7.6 years.
Results:
Demographics were similar in both groups regarding age, gender and most cardiovascular risk factors. However, patients with LVEF ≤35% more often had diabetes, renal insufficiency, chronic obstructive pulmonary disease and a previous history of myocardial infarction. Thirty-day mortality was 4 times higher (8% vs 2%, P < 0.001) in the LVEF ≤35%-group compared to controls. Overall survival was significantly lower in the LVEF ≤35%-group compared to controls, at 1 year (87% vs. 98%, P < 0.001) and 5 years (69% vs. 91%, P < 0.001). In multivariable analysis LVEF ≤35% was linked to inferior survival with an adjusted hazard ratio of 2.0 (95%-CI 1.5 - 2.6, p<0.001).
Conclusions:
A good long-term outcome after coronary artery bypass grafting can be expected for patients with reduced LVEF, however, their survival is still significantly inferior to patients with normal ventricular function.
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