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Published on: March 27, 2018
Outcomes of Emergent Isolated Coronary Bypass Grafting in Heart Failure Patients
Giacomo Bianchi1, Edoardo Zancanaro2, Rafik Margaryan1
1Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy.
Insights
Patients with heart failure (HF) undergoing emergency coronary artery bypass grafting (CABG) after acute myocardial infarction (AMI) have similar in-hospital mortality to those without HF. However, HF patients face higher risks for cardiogenic shock and long-term mortality.
Area of Science:
- Cardiology
- Cardiac Surgery
- Critical Care Medicine
Background:
- Patients with pre-existing heart failure (HF) face increased risks of morbidity and mortality following hospitalization for acute myocardial infarction (AMI).
- Emergent coronary artery bypass grafting (CABG) is a critical intervention for acute coronary syndromes, but outcomes in patients with comorbid HF require further investigation.
Purpose of the Study:
- To analyze the time trends in emergent CABG incidence for patients with and without HF.
- To compare clinical characteristics, outcomes, and mortality risk factors for surgical revascularization in these groups.
- To evaluate short- and medium-term prognoses after emergent CABG in patients with and without HF.
Main Methods:
- A single-center retrospective observational study included patients undergoing isolated emergency CABG between January 2009 and January 2020.
- Propensity-score matching created two comparable groups: patients with (n=215) and without (n=215) HF.
- Statistical analyses assessed in-hospital and short- to medium-term outcomes, including mortality risk factors.
Main Results:
- In-hospital mortality rates were similar between groups (2.8%; p > 0.9).
- Patients with HF more frequently presented with cardiogenic shock.
- Mechanical circulatory support (OR 16.7) and postoperative acute renal failure (OR 15.9) were associated with mortality.
- Mid-term mortality was linked to HF (HR 3.47), NSTEMI, and advanced age (HR 1.28).
Conclusions:
- Emergent CABG provides a favorable immediate prognosis for patients with acute coronary syndromes, even those with chronic heart failure.
- While in-hospital outcomes are comparable, heart failure patients require vigilant monitoring for complications like cardiogenic shock and acute renal failure.
- Long-term survival after surgical revascularization is influenced by the presence of heart failure and patient age.
Abstract:
Patients with previously diagnosed HF are at greater risk for subsequent morbidity and mortality when hospitalized for an Acute Myocardial Infarction (AMI). The purpose of our study was to describe the time trend of the incidence of emergent CABG in patients with and without HF, the clinical characteristics, outcomes, and the risk factors for mortality of surgical revascularization in the short and medium term. This was a single-center retrospective observational study of patients who underwent isolated emergency CABG from January 2009 to January 2020. A propensity-score matching analysis yielded two comparable groups (n = 430) of patients without (n = 215) and with (n = 215) heart failure. In-hospital mortality did not differ in the two groups (2.8%; p > 0.9); the patients with heart failure presented more frequently with cardiogenic shock, and there was an association with mortality and mechanical circulatory support (OR 16.7−95% CI 3.31−140; p = 0.002) and postoperative acute renal failure (OR 15.9−95% CI 0.66−203; p = 0.036). In the early- and mid-term, heart failure and NSTEMI were associated with mortality (HR 3.47−95% CI 1.15−10.5; p = 0.028), along with age (HR 1.28−95% CI 1.21−1.36; p < 0.001). Surgical revascularization offers an excellent solution for patients with acute coronary syndrome, leading to a good immediate prognosis even in those with chronic heart failure.
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