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Risk Factors and Long-Term Survival After Coronary Artery Bypass Grafting: Impact of Left Ventricular End-Diastolic
Sergey Gureev1, Alexander Kogan1, Nirit Agay2
1Department of Cardiac Surgery, Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel; Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Insights
Left ventricular end-diastolic diameter (LVEDD) predicts mortality after coronary artery bypass grafting (CABG). An LVEDD greater than 6.1 cm significantly increases mortality risk in patients undergoing isolated CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Research
Background:
- Left ventricular (LV) enlargement is a known negative prognostic factor in coronary artery bypass grafting (CABG).
- The precise impact of LV end-diastolic diameter (LVEDD) on post-CABG mortality requires further investigation.
Purpose of the Study:
- To evaluate the predictive capability of LVEDD for short- and long-term all-cause mortality following isolated CABG.
- To identify specific LVEDD thresholds associated with increased mortality risk.
Main Methods:
- Retrospective, single-center observational cohort study of 3,090 patients undergoing isolated CABG.
- Analysis of preoperative risk factors, including LVEDD, using logistic regression and ROC analysis.
- Subgroup analysis for patients with LVEF < 30%.
Main Results:
- In-hospital mortality was 1.3%; 5-year all-cause mortality was 8.1%.
- LVEDD (cut-off 5.1 cm) and elevated creatinine were key long-term mortality predictors.
- In patients with LVEF < 30%, LVEDD > 6.1 cm significantly reduced 1- and 3-year survival (AUC = 0.734).
Conclusions:
- LVEDD is a robust, independent predictor of mortality after isolated CABG.
- An LVEDD exceeding 6.1 cm is associated with markedly increased mortality risk.
Objectives:
Left ventricular (LV) enlargement is an unfavorable prognostic factor in coronary artery bypass grafting (CABG) outcomes. However, the extent of LV enlargement and its correlation with post-CABG mortality remain underexplored. This study evaluated the predictive value of LV end-diastolic diameter (LVEDD) on short- and long-term all-cause mortality following isolated CABG.
Design:
We conducted a retrospective, single-center observational cohort study. To evaluate their prognostic significance, we analyzed preoperative risk factors deemed crucial for mortality prediction using logistic regression and receiver operating characteristic analysis.
Setting:
Cardiac surgery department in Israel's largest university tertiary care center.
Participants:
The study population consisted of 3,090 patients who underwent isolated CABG over 13 years, between January 1, 2010, and December 31, 2022.
Interventions:
Isolated CABG.
Measurements And Main Results:
In-hospital mortality was 1.3%, with 1-year, 3-year, and 5-year all-cause mortality rates of 3.0%, 5.6%, and 8.1%, respectively. For long-term mortality, the key predictors were LVEDD, with a cut-off value of 5.1 cm, and elevated preoperative creatinine levels. Subgroup analysis of 221 patients with LVEF below 30% indicated that an LVEDD threshold of 6.1 cm significantly reduced survival rates at 1 and 3 years (AUC = 0.734; CI: 0.675-0.788; p < 0.0001).
Conclusions:
LVEDD is a strong, independent predictor of both short- and long-term mortality in patients undergoing isolated CABG. LVEDD > 6.1 cm markedly increases the mortality risk.
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