Key result
CABG for ischemic cardiomyopathy yields ~80% 5-year survival, with unimproved LV function predicting late mortality.
Why the study?
Data showing coronary artery bypass grafting improves survival in ischemic cardiomyopathy come from developed countries and may not apply to patients from India due to differing socioeconomic status, risk profiles, and healthcare access.
Does coronary artery bypass grafting improve survival and left ventricular function in Indian patients with ischemic cardiomyopathy and severe left ventricular dysfunction?
Does coronary artery bypass grafting improve survival and left ventricular function in Indian patients with ischemic cardiomyopathy and severe left ventricular dysfunction?
In Indian patients with ischemic cardiomyopathy and severe LV dysfunction, CABG is associated with high early operative mortality but good 5-year survival, with failure of LV function improvement strongly predicting late mortality.
Requires careful patient selection given early risks in Indian ischemic cardiomyopathy; leaves open generalizability of LV recovery as mortality predictor.
Background Many observational studies and trials have shown that coronary artery bypass grafting improves the survival in patients with ischemic cardiomyopathy. However, these results are based on data generated from developed countries. Poor socioeconomic statuses, lack of uniformity in healthcare delivery, differences in risk profile, and affordability to access optimal health care are some factors that make the conclusions from these studies irrelevant to patients from India. Methods and Results One‐hundred and sixty‐two patients with severe left ventricular dysfunction (ejection fraction ≤35%) who underwent coronary artery bypass grafting from 2009 to 2017 were enrolled for this study. Mean age of the study population was 58.67±9.70 years. Operative mortality was 11.62%. Thirty day/in‐house composite outcome of stroke and perioperative myocardial infarction were 5.8%. The percentage of survival for 1 year was 86.6%, and 5‐year survival was 79.9%. Five‐year event‐free survival was 49.3%. The mean ejection fraction improved from 30.7±4.08% (range 18–35) to 39.9±8.3% (range 24–60). Lack of improvement of left ventricular function was a strong predictor of late mortality (hazard ratio, 21.41; CI 4.33–105.95). Even though there was a trend towards better early outcome in off‐pump CABG , the 5‐year survival rates were similar in off‐pump and on‐pump group (73.4% and 78.9%, respectively; P value 0.356). Conclusions We showed that coronary artery bypass grafting in ischemic cardiomyopathy was associated with high early composite outcomes. However, the 5‐year survival rates were good. Lack of improvement of left ventricular function was a strong predictor of late mortality.
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Jose et al. (2019) studied this question. Coronary artery bypass grafting in ischemic cardiomyopathy resulted in a 5-year survival rate of 79.9%, with lack of left ventricular function improvement predicting late mortality (HR 21.41).
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