What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Ischemic heart disease with left ventricular systolic dysfunction (n=110). Intervention: Coronary artery bypass grafting (CABG) vs. Preoperative baseline. Primary outcome: Left ventricular ejection fraction (LVEF) (p=0.05).

August 4, 2019Open Access

Left ventricular function outcome after coronary artery bypass grafting, King Abdullah Medical City (KAMC)- single-center experience

Key Result

Coronary artery bypass grafting significantly improved mean left ventricular ejection fraction from 29.76% preoperatively to 33.53% postoperatively in patients with baseline LVEF < 50%.

Study Design

Type

Cross-Sectional (n=110)

Multicenter

Structured PICO

Does coronary artery bypass grafting improve left ventricular systolic function in patients with ischemic heart disease and LVEF < 50%?

Population

110 patients with left ventricular ejection fraction (LVEF) < 50% who underwent elective isolated CABG or CABG and mitral valve repair at a single center in Saudi Arabia. Mean age 56.1 ± 12.2 years, 70% male. Exclusions: normal LVEF, severe pulmonary hypertension, cardiogenic shock, atrial fibrillation, combined CABG with other valve intervention, no postoperative echocardiography follow-up, and EF < 20%.

Intervention

Coronary artery bypass grafting (CABG) alone (79%) or combined with mitral valve repair/replacement (21%).

Outcome

Change in left ventricular (LV) systolic function (LVEF) after surgery and predictors of adverse outcome/in-hospital mortality.surrogate

CABG significantly improves early postoperative left ventricular ejection fraction in patients with ischemic heart disease and baseline LVEF < 50%, though diabetes, advanced diastolic dysfunction, and IABP use predict higher in-hospital mortality.

Main Result

Absolute Event Rate: 33.53% vs 29.76%

p-value: p=0.05

Limitations

Limited number of patients due to the nature of a single center
Lack of echocardiography follow-up for some patients
Short follow-up duration (few months only)
Data regarding patency of grafts were not applicable

Abstract

BACKGROUND: Coronary artery bypass grafting is known to be associated with better outcome in ischemic heart disease patients with low ejection fraction. We aim to demonstrate the effect of coronary artery bypass grafting (CABG) on left ventricle (LV) systolic function and to identify the predictors that adversely lead to postoperative poor outcome. RESULT: This is a cross-sectional prospective study; we included 110 patients with left ventricular ejection fraction (LVEF) 35%, and group II, 34 (31%) patients with LVEF < 35%. Our results as regards demographic and clinical data revealed that group II patients had a significantly higher prevalence of diabetes mellitus (DM) and Euro SCORE II compared to group I patients (p = 0.05 and < 0.001 respectively); otherwise, all other clinical predictors did not differ between the two studied groups. There was a significant improvement in LVEF post-surgery (p = 0.05) in both groups with observed no significant difference recorded for in-hospital mortality rate among patients with different groups. DM, significant diastolic dysfunction, and insertion of IABP are predictors of in-hospital mortality of the patients (p = 0.001, 0.03 and < 0.001, respectively) CONCLUSION: We concluded that there is a significant improvement of LV systolic function after CABG and hence better survival rate. DM, significant diastolic dysfunction, and perioperative insertion of IABP are predictors of mortality after cardiac surgery. Special care should be provided to such patients to improve their outcome.

Mark Helpful

Bookmark

Relay

View Full Paper