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Published on: March 27, 2018
Predicting outcomes in patients with low ejection fraction undergoing coronary artery bypass graft
Mohammad Sadeq Najafi1,2, Soroush Nematollahi1, Ahmad Vakili-Basir1,3
1Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Patients with reduced left ventricular ejection fraction (LVEF) undergoing coronary artery bypass grafting have a 68% nine-year survival rate. Mitral regurgitation, valvular heart disease, and renal function predict mortality in these high-risk cardiac surgery patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Outcomes Research
Background:
- Reduced left ventricular ejection fraction (LVEF) is a significant predictor of adverse outcomes post-cardiac surgery.
- Coronary artery bypass grafting (CABG) is a common intervention for coronary artery disease.
Purpose of the Study:
- To evaluate the clinical outcomes and survival rates in patients with low LVEF undergoing CABG.
- To identify independent predictors of mortality and major adverse cardiac and cerebrovascular events (MACCE) in this patient cohort.
Main Methods:
- Retrospective cohort study including patients with LVEF ≤ 40% who underwent CABG.
- Data collected from March 2007 to March 2016 with a median follow-up of nine years.
- Multivariable Cox regression analysis was used to identify predictors of mortality and MACCE.
Main Results:
- The study included 5,532 patients (79% male, mean age 65.58).
- Nine-year overall survival was 68%, with 55% experiencing MACCE.
- Independent predictors of mortality included moderate to severe mitral regurgitation, GFR ≤ 60, mild right ventricular dysfunction, and valvular heart disease.
Conclusions:
- Mitral regurgitation, valvular heart disease, and renal function are clinically significant in patients with low LVEF undergoing CABG.
- Identifying these predictors aids in risk stratification and improving patient outcomes after cardiac surgery.
Introduction:
Reduced left ventricular ejection fraction (LVEF) is a well-known predictor of adverse events after cardiac surgery. We aimed to assess the outcomes in patients with low LVEF undergoing coronary artery bypass graft.
Methods:
In this retrospective cohort, we included all patients with left ventricular ejection fraction ≤ 40 who underwent coronary artery bypass grafting between March 2007 and March 2016 (with a median follow-up of nine years) at Tehran Heart Center. Demographics and clinical characteristics were extracted from the data registry. Akaike information criterion (AIC) was used. The univariate Cox regression was performed. We investigated the predictors of mortality and major adverse cardiac and cerebrovascular events (MACCE) using Cox multivariable regression.
Results:
In total, 5,532 cases (79 % male) with a mean age of 65.58 were included in the study. The nine-year overall survival was calculated at 68 %, and more than half of the patients had MACCE (55 %). In adjusted multivariable Cox regression analysis, moderate to severe mitral valve regurgitation, glomerular filtration rate ≤ 60, mild right ventricular dysfunction, and valvular heart disease independently predicted higher mortality. The abovementioned predictors and peripheral vascular disease significantly increased MACCE.
Conclusion:
Our study indicates the clinical significance of mitral regurgitation, valvular heart disease, and renal function in patients with low ejection fraction treated by coronary artery bypass grafting surgery. Identifying predictors of adverse events can help with clinical decision-making and risk stratification, ultimately improving patient outcomes.
