One Year Survival of High-Risk Patients Undergoing Coronary Revascularization

In high-risk patients requiring coronary artery bypass grafting (CABG) we sought to evaluate the differential impact of comorbid and cardiovascular risk factors on perioperative versus one year survival with the hypothesis that different phenotypes of perioperative risk may portend different longitudinal outcomes and that not all high-risk features are equivalent.

The Society Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) was used to assess all patients (n=75,385) ≥65 years of age undergoing isolated CABG with a predicted risk of mortality (PROM) greater than 4% (2012-2022). The database was linked with Centers for Medicare & Medicaid Services (CMS) claims data to evaluate one-year mortality. Change in risk-adjusted odds ratios for 30-day and 1-year mortality were assessed using landmark analysis to identify variables associated with early versus late mortality.

A total of 67,376 (89.4%) patients survived 30-days of those 8,998 (13.4%) died between 30 days and one year. Liver disease and home oxygen were associated with increased mortality at both 30 days and 1 year. However, unresponsive state, prior CABG, percutaneous coronary intervention (PCI) within 6 hours, cardiogenic shock, and temporary mechanical support were associated with early mortality but exhibited no significant effects at 1 year. Finally, cancer, Medicaid coverage, and dialysis were initially neutral for 30-day mortality but emerged as independent risk factors for 1-year mortality.

In high-risk CABG, prognostic determinants evolve over time. These findings underscore the importance of incorporating temporal risk dynamics into clinical decisions.