Preoperative hemodynamic instability (AOR 4.57; 95% CI 1.53-13.7) and serum creatinine >166 µmol/L (AOR 3.46) independently predicted 30-day mortality after CABG in patients with EF ≤30%.
Cohort (n=346)
No
What are the independent risk factors for 30-day mortality and complications in patients with low EF (≤30%) undergoing CABG?
In patients with severe left ventricular dysfunction (EF ≤30%) undergoing CABG, preoperative hemodynamic instability and elevated serum creatinine are strong independent predictors of 30-day mortality.
Effect estimate: AOR 4.57 (95% CI 1.53-13.7)
p-value: p=0.007
BACKGROUND: Left ventricular (LV) dysfunction alone is insufficient as an independent predictor of postoperative complications and mortality in coronary artery bypass graft (CABG) surgery. Our objective was to identify additional independent risk factors in patients with low left ventricle ejection fraction (EF) who underwent CABG. METHODS: We retrospectively analyzed CABG results of 346 consecutive patients with low EF (≤30%) in a single institution between 2009 and 2015. The primary study endpoint was 30-day all-cause mortality. The secondary endpoints were the development of major adverse cardiac events (MACE) and renal complications after operation. A subgroup of patients underwent additional analyses of the interaction between extents of viable myocardium and postoperative endpoints. RESULTS: The analysis showed that preoperative hemodynamic instability (AOR=4.57; 95% CI: 1.53-13.7, P=0.007) and serum creatinine >166 µmol/L (AOR=3.46; 95% CI: 1.12-10.7, P=0.031) were independent predictors of 30-day death. Both urgent and emergency operations were predictors for MACE (P=0.038; P=0.005) and renal complications (P=0.004; P=0.007). Pre-existing diabetes mellitus increased the likelihood of renal complications (P=0.020). In the sub-analysis of patients with viable myocardium, the mortality was significantly lower with predicted mortality (P=0.014). CONCLUSIONS: Patients with significant LV dysfunction undergoing isolated CABG have fair short-term survival even with EF less than 30%. Hemodynamic instability prior to operation and preoperative kidney dysfunction are strong predictors of mortality in patients with low EF. Favorable coronary targets, meticulous operative techniques, and optimal surgical timing before hemodynamic deterioration occurs are essential to minimize the risk of revascularization complications and early postoperative mortality.
Vickneson et al. (Wed,) conducted a cohort in Coronary artery disease with low ejection fraction (n=346). Coronary artery bypass grafting (CABG) was evaluated on 30-day all-cause mortality (AOR 4.57, 95% CI 1.53-13.7, p=0.007). Preoperative hemodynamic instability (AOR 4.57; 95% CI 1.53-13.7) and serum creatinine >166 µmol/L (AOR 3.46) independently predicted 30-day mortality after CABG in patients with EF ≤30%.