Key result
In patients undergoing emergent isolated CABG, pre-existing heart failure was associated with increased early- and mid-term mortality (HR 3.47; 95% CI 1.15-10.5; P=0.028), despite similar in-hospital mortality (2.8%).
Why the study?
Patients with prior HF face higher morbidity and mortality during AMI hospitalization, prompting evaluation of incidence trends, outcomes, and mortality risk factors after emergent CABG.
Does emergent isolated CABG result in different mortality outcomes in patients with versus without heart failure?
Observational (n=430)
No
Does emergent isolated CABG result in different mortality outcomes in patients with versus without heart failure?
Emergent isolated CABG for acute coronary syndrome provides good immediate survival even in patients with chronic heart failure, with comparable in-hospital mortality to those without heart failure.
Answers are grounded in this paper and cite their sources.
Comparable in-hospital mortality after emergent CABG regardless of heart failure; leaves open its independent link to early- and mid-term risk.
Patients with previously diagnosed HF are at greater risk for subsequent morbidity and mortality when hospitalized for an Acute Myocardial Infarction (AMI). The purpose of our study was to describe the time trend of the incidence of emergent CABG in patients with and without HF, the clinical characteristics, outcomes, and the risk factors for mortality of surgical revascularization in the short and medium term. This was a single-center retrospective observational study of patients who underwent isolated emergency CABG from January 2009 to January 2020. A propensity-score matching analysis yielded two comparable groups (n = 430) of patients without (n = 215) and with (n = 215) heart failure. In-hospital mortality did not differ in the two groups (2.8%; p > 0.9); the patients with heart failure presented more frequently with cardiogenic shock, and there was an association with mortality and mechanical circulatory support (OR 16.7−95% CI 3.31−140; p = 0.002) and postoperative acute renal failure (OR 15.9−95% CI 0.66−203; p = 0.036). In the early- and mid-term, heart failure and NSTEMI were associated with mortality (HR 3.47−95% CI 1.15−10.5; p = 0.028), along with age (HR 1.28−95% CI 1.21−1.36; p < 0.001). Surgical revascularization offers an excellent solution for patients with acute coronary syndrome, leading to a good immediate prognosis even in those with chronic heart failure.
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Bianchi et al. (2022) conducted an observational in Acute Myocardial Infarction requiring emergent CABG (n=430). Heart failure vs. No heart failure was evaluated on In-hospital mortality (p=> 0.9). In patients undergoing emergent isolated CABG, pre-existing heart failure was associated with increased early- and mid-term mortality (HR 3.47; 95% CI 1.15-10.5; P=0.028), despite similar in-hospital mortality (2.8%).
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