Risk stratification of outcomes after coronary artery bypass grafting in ischemic cardiomyopathy with symptomatic...

To identify the predictors of all-cause mortality and heart failure (HF) events in patients with ischemic cardiomyopathy (ICM) undergoing isolated coronary artery bypass (CABG) grafting who present with symptomatic HF, and to identify potential stratification variables for future regenerative therapy trials.

We retrospectively analyzed data from 90 patients with ICM, left ventricular ejection fraction of ≤ 40%, and New York Heart Association class ≥ II who underwent primary isolated CABG. Clinical characteristics, operative data, and long-term outcomes were assessed. The primary endpoints were all-cause mortality and incidence of HF events, defined as a composite of all-cause mortality and initial HF readmission. Prognostic factors were evaluated using Kaplan-Meier analyses and multivariate Cox proportional hazard models.

During the median follow-up period of 45 months, 27 (30.0%) deaths, 14 (15.6%) HF readmissions, and 38 (42.2%) HF events occurred. Multivariate analysis identified older age (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.02-1.17) and high creatinine levels (HR, 1.62; 95% CI, 1.23-2.13) as independent predictors of all-cause mortality and HF events. A history of percutaneous coronary intervention was independently associated with all-cause mortality (HR, 2.60; 95% CI, 1.09-6.22). Total revascularization was independently protective against all-cause mortality (HR, 0.21; 95% CI, 0.06-0.74).

Among symptomatic patients with ICM undergoing CABG, older age, high creatinine levels, and a history of percutaneous coronary intervention were associated with worse survival outcomes, whereas total revascularization was associated with improved survival. These findings should be interpreted as exploratory and may help identify potential stratification variables for future prospective studies of adjunctive regenerative therapy.