Key result
Preoperative renal failure was a strong independent predictor of aggravated left ventricular diastolic dysfunction after off-pump coronary artery bypass grafting (OR 2.47), which in turn significantly increased the risk of major adverse cardiac and cerebrovascular events.
Why the study?
Does aggravated left ventricular diastolic dysfunction after off-pump coronary artery bypass grafting predict worse long-term clinical outcomes?
Cohort (n=1,101)
No
Does aggravated left ventricular diastolic dysfunction after off-pump coronary artery bypass grafting predict worse long-term clinical outcomes?
Aggravation of left ventricular diastolic dysfunction after off-pump CABG is associated with significantly worse long-term survival and higher rates of MACCE.
Answers are grounded in this paper and cite their sources.
Aggravated LVDD after OPCAB may aid postoperative risk stratification; leaves open whether mitigation improves late outcomes in prospective trials.
BACKGROUND: To determine the predictors of aggravated left ventricular diastolic dysfunction (LVDD) in patients undergoing off-pump coronary artery bypass grafting (OPCAB) and to compare late outcomes according to the aggravated LVDD. METHODS AND RESULTS: OPCAB was performed in 1,101 patients (2001-2013). LVDD was classified as normal, mild, moderate or severe. Patients were divided into 2 groups: non-aggravated LVDD (group I) and aggravated LVDD (group II). The primary endpoint was aggravation of LVDD. The secondary endpoint was late mortality and morbidity such as major adverse cardiac and cerebrovascular events (MACCE) related to LVDD aggravation postoperatively. There were 894 patients in group I and 207 in group II. Multivariate analysis revealed that preoperative peripheral artery obstructive disease (PAOD) (P=0.04), renal failure (P<0.01), and A' velocity (P<0.01) anticipated aggravated LVDD. The Cox hazards model revealed that aggravated LVDD was a poor prognostic factor for MACCE (P<0.01) and overall survival (P<0.01). The Kaplan-Meier survival curve showed that aggravated LVDD was related to poor late outcomes (freedom from MACCE, P=0.01; overall survival, P<0.01). CONCLUSIONS: Aggravated LVDD significantly affects late clinical outcomes after OPCAB and preoperative PAOD, renal failure, and A' velocity might be predictors. (Circ J 2016; 80: 1937-1945).
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Lee et al. (2016) conducted a cohort in Coronary artery disease (n=1,101). Preoperative renal failure vs. Normal renal function was evaluated on Aggravated left ventricular diastolic dysfunction (LVDD) (OR 2.47, 95% CI 1.55-3.94, p=<0.01). Preoperative renal failure was a strong independent predictor of aggravated left ventricular diastolic dysfunction after off-pump coronary artery bypass grafting (OR 2.47), which in turn significantly increased the risk of major adverse cardiac and cerebrovascular events.
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