Key result
In patients undergoing isolated on-pump CABG, a reduced ejection fraction (<35%) was associated with a significantly higher risk of mortality (OR 2.2) compared to an ejection fraction ≥35%.
Why the study?
The role of CABG in patients with reduced ejection fraction has been unclear, prompting evaluation of the outcomes of isolated CABG in these patients.
Cohort (n=350)
No
Effect estimate: OR 2.2 (95% CI 0.9-5.3)
Absolute Event Rate: 8.5% vs 2.6%
p-value: p=0.004
Background: The role of CABG in patients with reduced ejection fraction has been unclear, and several studies have shown that CABG can be performed safely in those patients. Aim: The purpose of this study was to evaluate the final outcome of isolated CABG surgery in patients with reduced EF before surgery. Materials and Methods: This retrospective analytical study involved 350 patients who underwent isolated CABG and were admitted to the Department of Cardiac Surgery, Tishreen University Hospital, Lattakia, during the four-year period 2017-2020. Patients were divided into two groups according to EF: <35%(47 cases) and ≥35%(303 cases), and final outcomes were compared between the two groups. Results: Ages of the study population range from 31 to 84 years, with a mean age of 61.9±6.8. Males represented 71.7% of the patients with a male-to-female ratio of 2.5:1. There was an increase in post-operative EF on average of 4.6% in patients with EF <35%)33.7±1.8 versus 30.5±2.6 before surgery). Lower levels of EF were associated significantly with higher frequency of post-operative use of inotropic agents (12.8 versus 3.3%, p:0.03), reoperation due to bleeding (4.2% versus 1.6%, p:0.04), kidney injury (6.4% versus 0.3%, p:0.01) and mortality (8.5% versus 2.6%, p:0.03). Duration of hospitalization was significantly longer in patients with EF<35%(6.7±2.3 versus 4.2±1.9, p:0.005). In multivariate regression analysis, reduced EF was associated with prolonged use of inotropic agents (OR: 2.7,95% CI: 1.2-9.3, p: 0.0001), kidney injury (OR:2.1,95% CI: 0.9-7.2, p:0.001), reoperation due to bleeding (OR: 2.1,95% CI 1.1-5.7, p=0.01), and mortality (OR:2.2,95% CI: 0.9-5.3, p:0.004).Conclusion: Low ejection fraction at admission is a prognostic factor for morbidity and mortality in patients who underwent CABG surgery.
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souliman et al. (2023) conducted a cohort in Coronary artery disease with reduced ejection fraction (n=350). On-pump CABG (EF <35%) vs. On-pump CABG (EF ≥35%) was evaluated on Mortality (OR 2.2, 95% CI 0.9-5.3, p=0.004). In patients undergoing isolated on-pump CABG, a reduced ejection fraction (<35%) was associated with a significantly higher risk of mortality (OR 2.2) compared to an ejection fraction ≥35%.
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