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Coronary artery bypass grafting in patients with COPD
L E Samuels1, M S Kaufman, R J Morris
1Department of Cardiothoracic Surgery, Allegheny University Hospitals, Hahnemann Division, Philadelphia, PA 19102-1192, USA.
Insights
Coronary artery bypass grafting (CABG) is safe for most patients with mild-to-moderate chronic obstructive pulmonary disease (COPD). However, elderly patients with severe COPD on steroids face exceptionally high mortality risks with CABG.
Area of Science:
- Cardiovascular Surgery
- Pulmonary Medicine
- Critical Care Medicine
Background:
- Chronic obstructive pulmonary disease (COPD) is a significant comorbidity affecting cardiovascular surgery outcomes.
- Defining the specific risks associated with COPD in patients undergoing coronary artery bypass grafting (CABG) is crucial for surgical decision-making.
Purpose of the Study:
- To elucidate the impact of chronic obstructive pulmonary disease (COPD) on outcomes following coronary artery bypass grafting (CABG).
- To identify specific patient subgroups within the COPD population who experience increased mortality or morbidity after CABG.
Main Methods:
- A cohort of 191 patients with COPD undergoing CABG between March 1995 and June 1996 was analyzed.
- COPD was defined by the need for pulmonary therapy or an FEV1 <75% of predicted value.
- Outcomes including hospital mortality, morbidity, and length of stay were assessed.
Main Results:
- Overall hospital mortality was 7%, with 50% experiencing hospital morbidity.
- Significant morbidities included pulmonary complications (12%) and atrial fibrillation (27%).
- Mortality was notably higher in specific subgroups: COPD patients with pneumonia (11%), those on steroids (19%), patients aged >= 75 (17%), and critically, those >= 75 and on steroids (50%).
Conclusions:
- CABG demonstrates acceptable hospital mortality for the majority of patients with mild-to-moderate COPD.
- Elderly patients (>= 75 years) with severe COPD who are on steroid therapy represent a high-risk group, warranting careful consideration.
- Nonsurgical management should be strongly considered for this high-risk subgroup of elderly COPD patients on steroids.
Objective:
To more fully define the influence of COPD in patients undergoing coronary artery bypass grafting (CABG).
Methods:
One hundred ninety-one patients with COPD underwent CABG from March 1, 1995, to June 21, 1996. There were 129 male and 62 female patients. The mean age was 69 years (45 to 86 years). Patients with COPD were defined according to the Summit Database definition: requires therapy for the treatment of chronic pulmonary compromise or has an FEV1 <75% of predicted value.
Results:
Hospital mortality was 7%. Hospital morbidity was 50%. Statistically significant (p<0.05) morbidity included general pulmonary complications (12%) and atrial fibrillation (27%). Hospital mortality for COPD patients with postoperative pneumonia was 11%. Hospital mortality for patients with COPD receiving steroids was 19%. The hospital mortality for patients > or = 75 years of age was 17%. The combined mortality for patients with COPD who are > or = 75 years of age and receiving steroid therapy was 50%. The mean length of stay was 12 days. Late mortality was 1% at a mean of 1.5 years.
Conclusions:
Hospital mortality in most patients with mild-to-moderate COPD undergoing CABG is similar to those without COPD. In the minority of patients with severe COPD who are receiving steroids and > 75 years, the hospital mortality is exceptionally high. These findings support CABG in patients with mild-to-moderate COPD. Nonsurgical therapy should be considered for elderly COPD patients with severe disease taking steroids.