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Periprocedural Risk Predictors Affecting Long-Term Prognosis in Patients With Chronic Obstructive Pulmonary Disease
Aleksander Dokollari1,2, Serge Sicouri1, Leila Hosseinian2
1Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania.
Insights
Patients with chronic obstructive pulmonary disease (COPD) undergoing coronary artery bypass grafting (CABG) face higher long-term mortality. Key risk factors for death include atrial fibrillation, diabetes, and male sex.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Surgical Outcomes
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
- Chronic obstructive pulmonary disease (COPD) is a significant comorbidity that may impact surgical outcomes.
- Identifying risk predictors is crucial for improving long-term prognosis in COPD patients undergoing CABG.
Purpose of the Study:
- To identify periprocedural risk predictors for long-term prognosis in patients with COPD undergoing isolated CABG.
- To compare long-term outcomes between patients with and without COPD after isolated CABG.
Main Methods:
- A propensity-matched analysis of 4,871 patients undergoing isolated CABG between May 2005 and June 2021.
- Comparison of baseline demographics and preoperative characteristics between COPD and non-COPD groups.
- Primary outcome was long-term incidence of all-cause death.
Main Results:
- After matching, 767 patients were in each group (COPD vs. non-COPD).
- Patients with COPD had longer operating room time, ICU stay, and hospital length of stay.
- The COPD group exhibited a significantly higher rate of all-cause death (18.3% vs. 14.5%) during a median follow-up of 4.0 years.
- Periprocedural risk predictors for all-cause death in COPD patients included atrial fibrillation, diabetes, male sex, dialysis, ejection fraction <50%, peripheral vascular disease, and STS score >4%.
Conclusions:
- Patients with COPD undergoing isolated CABG have a significantly higher long-term incidence of all-cause death compared to those without COPD.
- Specific periprocedural risk factors are identified, aiding in risk stratification and management for COPD patients undergoing CABG.
Objective:
This study sought to identify periprocedural risk predictors that affect long-term prognosis in patients with chronic obstructive pulmonary disease (COPD) undergoing isolated coronary artery bypass grafting (CABG).
Methods:
All consecutive 4,871 patients undergoing isolated CABG between May 2005 and June 2021 were included. Patients with and without COPD were compared for baseline demographics and preoperative characteristics. A propensity-matched analysis was used to compare the 2 groups. The primary outcome was long-term incidence of all-cause death.
Results:
After matching, 767 patients each were included in the COPD and non-COPD groups; mean age was 71.6 and 71.4 years (P = .7), respectively; 29.3% and 32% (P = .2) were women, respectively. Intraoperatively, median (IQR) operating room time was higher in the COPD group than in the non-COPD group (5.9 [5.2-7.0] hours vs 5.8 [5.1-6.7] hours, respectively; P = .01). Postoperatively, intensive care unit stay (P = .03), hospital length of stay (P = .0004), and fresh frozen plasma transfusion units (P = .012) were higher in the COPD group than in the non-COPD group. Thirty-day mortality was not different between groups (1.3% in the COPD group vs 1% in the non-COPD group; P = .4). Median follow-up time was 4.0 years. The rate of all-cause death was higher in the COPD group than in the non-COPD group (138 patients [18.3%] vs 109 patients [14.5%], respectively; P = .042). Periprocedural risk predictors for all-cause death in patients with COPD were atrial fibrillation, diabetes, male sex, dialysis, ejection fraction less than 50%, peripheral vascular disease, and Society of Thoracic Surgeons Predicted Risk of Mortality score greater than 4%.
Conclusion:
Patients with COPD undergoing isolated CABG had a significantly higher incidence of all-cause death than those without COPD. Herein, risk predictors are provided for all-cause death in patients undergoing isolated CABG.
