Journal Article

Significance of preoperative left ventricular ejection fraction in 5-year outcome after isolated CABG

Ajam, Ali, Bagheri, Jamshid, Sadeghian, Saeed, Mansourian, Soheil, Pashang, Mina, Shirzad, Mahmoud, Fallahzadeh, Aida, Hosseini, Kaveh, Sheikhy, Ali, Momtahen, Shahram

2021

Overview

Background Pre-operative ejection fraction (EF) and comorbidities affect post-op outcomes. We aimed to compare the mortality and adverse events of patients with different baseline EF and also to evaluate the distribution of comorbidities in each EF group. Methods A total of 20,937 patients who underwent isolated coronary artery bypass graft (CABG) surgery from January 2006 to December 2016 was included. Patients were divided into three groups based on their pre-operative left ventricular EF as follows; (1) Normal: EF ≥ 50%; (2) Mild to moderately reduced: 50% < EF ≤ 35%; and (3) Severely reduced: EF < 35%. The backward elimination method was considered for multivariate Cox-regression analysis to locate predictors of mortality and non-fatal cerebro-cardiovascular events (CCVEs). The median follow-up time was 5.61 [3.12–8.0] years. Results The mean age in the total population was 60.94 ± 9.51 years and 73.6% of the total population was male. Diabetes mellitus was the common risk factor of mortality and CCVE in all EF groups. Impaired renal function (GFR < 60 ml/min) was associated with a higher risk of mortality after CABG regardless of EF level. The median 5-year mortality rate in patients with normal EF, mild-moderately reduced EF and severely reduced EF were 9.5%, 12.8%, and 22.7% respectively ( P  < 0.001). Although the trend of CCVEs was higher in severe left ventricle (LV) dysfunction, it was not statistically significant ( p  = 0.071). Conclusion Patients with severely reduced EF are at higher risk of mortality after CABG compared to those with higher EF levels; however, the rate of CCVEs may not be necessarily higher after adjustment for multiple pre-operative comorbidities.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Age / Aged / Analysis / Cardiac patients / Cardiac Surgery / Cardiovascular disease / Cardiovascular diseases / Carotid arteries / Chronic obstructive pulmonary disease / Comorbidity / Coronary artery / Coronary Artery Bypass / Coronary artery bypass graft (CABG) / Coronary vessels / Diabetes / Diabetes mellitus / Ejection fraction / Family medical history / Gender / Health aspects / Heart / Humans / Hypertension / Left ventricular ejection fraction (LVEF) / Male / Medicine / Medicine & Public Health / Middle Aged / Mortality / Patients / Regression analysis / Renal function / Research Article / Retrospective Studies / Risk analysis / Risk Factors / Statistical analysis / Stroke Volume / Surgery / Survival analysis / Sutures / Thoracic Surgery / Treatment Outcome / Variables / Variance analysis / Vein & artery diseases / Ventricle / Ventricular Dysfunction, Left / Ventricular Function, Left