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Published on: March 27, 2018
Functional Status Indicators and Long-Term Mortality Following Elective Coronary Artery Bypass Grafting: A
Yonatan Moshkovits1,2, Rachel Dankner3,4, Arnona Ziv3
1Department of Cardiology Rabin Medical Center Petah Tikva Israel.
Insights
Self-perceived health is a stronger predictor of long-term mortality after coronary artery bypass grafting than other functional status measures. This simple indicator should be used for risk stratification in cardiac surgery patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Health Outcomes Research
Background:
- Coronary artery bypass grafting (CABG) is a prevalent major surgical procedure globally.
- The prognostic significance of preoperative functional status indicators for long-term mortality post-CABG requires further elucidation.
- Key indicators include self-perceived health, MacNew physical domain score, and estimated maximum oxygen consumption.
Purpose of the Study:
- To evaluate the prognostic value of preoperative functional status measures for long-term mortality in patients undergoing CABG.
- To compare the predictive capabilities of self-perceived health, MacNew physical domain score, and estimated maximum oxygen consumption.
Main Methods:
- A cohort of 1146 patients undergoing CABG across 7 Israeli hospitals was analyzed.
- Three functional status indicators were assessed preoperatively: self-perceived health, MacNew physical domain score, and estimated maximum oxygen consumption.
- Multivariable Cox regression models were employed to examine associations with all-cause mortality.
Main Results:
- Over a median follow-up of 15.4 years, 59.6% of patients died.
- All assessed functional status indicators were associated with mortality.
- Impaired self-perceived health emerged as the strongest predictor (HR, 1.43), followed by low maximum oxygen consumption (HR, 1.2) and poor MacNew physical domain score (HR, 1.2).
Conclusions:
- Self-perceived health demonstrated superior prognostic value compared to other functional status measures.
- This single-question indicator offers significant incremental value for mortality prediction.
- Self-perceived health should be integrated into risk stratification protocols for patients undergoing CABG.
Background:
Coronary artery bypass grafting is the most commonly performed major surgical procedure worldwide. The prognostic value of preoperative functional status measures, including self-perceived health, the physical domain of the MacNew heart-related quality of life score, and estimated maximum oxygen consumption for long-term mortality remains unclear.
Methods:
We included 1146 patients undergoing coronary artery bypass grafting across 7 hospitals in Israel. Three functional status indicators were assessed: self-perceived health, MacNew physical domain score, and estimated maximum oxygen consumption. Associations with all-cause mortality were examined using multivariable Cox regression.
Results:
Participants had a mean age of 65.6 ± 10 years, and 260 (23%) were female. Over a median follow-up of 15.4 years (interquartile range, 10), 687 (59.6%) patients died. Multivariable Cox regression identified all functional status indicators to associate with mortality. Impaired self-perceived health was the strongest predictor of mortality (hazard ratio [HR], 1.43 [95% CI, 1.2-1.7], P<0.001), followed by low baseline maximum oxygen consumption (HR, 1.2 [95% CI, 1.0-1.5], P=0.05) and poor MacNew physical domain score (HR, 1.2 [95% CI, 1.0-1.4], P=0.02). Discrimination, according to Harrell's C statistic was highest for self-perceived health (C-index, 0.729 [95% CI, 0.7-0.8], P<0.001). Net reclassification improvement analysis confirmed that self-perceived health provided the greatest incremental value, correctly reclassifying 30% of participants (95% CI, 0.2-0.5; P<0.001) for mortality.
Conclusions:
Self-perceived health demonstrated better prognostic value, exceeding the functional status measures examined. Self-perceived health, a single question indicator, should be considered a key measure for risk stratification and prognosis following coronary artery bypass grafting.
Registration:
URL: https://clinicaltrials.gov; Unique identifier: NCT00356863.