Key result
Preoperative echocardiographic parameters, including severe diastolic dysfunction (OR 2.96; 95% CI 1.59-5.49), predicted in-hospital mortality or major morbidity after coronary artery bypass surgery.
Why the study?
Does preoperative echocardiography improve the prediction of mortality and major morbidity compared to the STS risk score alone in patients undergoing isolated coronary artery bypass surgery?
Cohort (n=854)
Yes
Does preoperative echocardiography improve the prediction of mortality and major morbidity compared to the STS risk score alone in patients undergoing isolated coronary artery bypass surgery?
Odds Ratio: 2.96 (95% CI 1.59–5.49)
Preoperative echocardiography, particularly the assessment of right ventricular dysfunction and restrictive left ventricular filling, provides incremental prognostic value over clinical risk scores for patients undergoing coronary artery bypass surgery.
May support incorporating diastolic function into CABG risk models; leaves open incremental value over STS score alone pending validation.
BACKGROUND: Although echocardiography is commonly performed before coronary artery bypass surgery, there has yet to be a study examining the incremental prognostic value of a complete echocardiogram. METHODS AND RESULTS: Patients undergoing isolated coronary artery bypass surgery at 2 hospitals were divided into derivation and validation cohorts. A panel of quantitative echocardiographic parameters was measured. Clinical variables were extracted from the Society of Thoracic Surgeons database. The primary outcome was in-hospital mortality or major morbidity, and the secondary outcome was long-term all-cause mortality. The derivation cohort consisted of 667 patients with a mean age of 67.2±11.1 years and 22.8% females. The following echocardiographic parameters were found to be optimal predictors of mortality or major morbidity: severe diastolic dysfunction, as evidenced by restrictive filling (odds ratio, 2.96; 95% confidence interval, 1.59-5.49), right ventricular dysfunction, as evidenced by fractional area change <35% (odds ratio, 3.03; 95% confidence interval, 1.28-7.20), or myocardial performance index >0.40 (odds ratio, 1.89; 95% confidence interval, 1.13-3.15). These results were confirmed in the validation cohort of 187 patients. When added to the Society of Thoracic Surgeons risk score, the echocardiographic parameters resulted in a net improvement in model discrimination and reclassification with a change in c-statistic from 0.68 to 0.73 and an integrated discrimination improvement of 5.9% (95% confidence interval, 2.8%-8.9%). In the Cox proportional hazards model, right ventricular dysfunction and pulmonary hypertension were independently predictive of mortality over 3.2 years of follow-up. CONCLUSIONS: Preoperative echocardiography, in particular right ventricular dysfunction and restrictive left ventricular filling, provides incremental prognostic value in identifying patients at higher risk of mortality or major morbidity after coronary artery bypass surgery.
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Afilalo et al. (2012) conducted a cohort in Coronary artery bypass surgery (n=854). Preoperative echocardiogram abnormalities (e.g., severe diastolic dysfunction) vs. Absence of echocardiographic abnormalities was evaluated on In-hospital mortality or major morbidity (OR 2.96, 95% CI 1.59-5.49). Preoperative echocardiographic parameters, including severe diastolic dysfunction (OR 2.96; 95% CI 1.59-5.49), predicted in-hospital mortality or major morbidity after coronary artery bypass surgery.
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