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DOI: 10.1055/s-0039-1678953
Prevalence and Outcome of CABG in Patients with Severely Reduced Ejection Fraction
Publikationsverlauf
Publikationsdatum:
28. Januar 2019 (online)
Objectives: Although CABG has a beneficial effect on CV mortality in patients with heart failure,1 little data exist on the characteristics of this patient cohort. The aim of this study was to identify prevalence and outcome of patients with severely reduced ejection fraction undergoing isolated CABG.
Methods: A total of 7,350 consecutive patients who underwent isolated CABG from January 2015 to May 2017 were registered in the E-CABG database. This registry is a prospective, multicenter study that enrolled CABG patients at 16 European centers. Clinical and follow-up characteristics were compared between patients with an ejection fraction of ≤30% (group I) and patients with an ejection fraction of >30% (group II).
Results: Of 7,350 patients, 330 (4.5%) patients showed a severely reduced ejection fraction ≤30% in preoperative echocardiography (group I).
Patients of group I appeared with acute coronary syndrome (ACS) more frequently (67.9% [n = 224] vs. 49.3% [n = 3,458]; p < 0.00001). They presented in critical preoperative state more often (30.6% [n = 101] vs. 5.4% [n = 377]; p < 0.00001) and were treated as emergency procedure more frequently (14.2% [n = 47] vs. 4.3% [n = 301]; p < 0.00001).
Adjusted logistic regression analysis did not show significant differences between 30-day (group I: 6.4% [n = 21], group II: 1.8% [n = 124]; p = 0.916) or 1-year mortality (group I: 13.6% [n = 28], group II: 4.7% [n = 215]; p = 0.219) between group I and group II. However, the adjusted logistic regression analysis of the composite endpoint of postoperative acute kidney injury, stroke, myocardial infarction, and 1-year death was significantly more often reached in group I when compared to group II (46.5% [n = 93] vs. 29.6% [n = 1,330]; p = 0.032).
Conclusions: Patients with severely reduced ejection fraction more frequently present with ACS and show a more critical preoperative state when compared to patients with ejection fraction >30%. Even when adjusted for these divergent baseline parameters a severely reduced ejection fraction in CABG patients is associated with an impaired midterm outcome as these patients more frequently reach the composite endpoint.
1. Petrie MC, et al. Ten-year outcomes after coronary artery bypass grafting according to age in patients with heart failure and left ventricular systolic dysfunction clinical perspective: an analysis of the extended follow-up of the STICH Trial (Surgical Treatment for Ischemic Heart Failure). Circulation 2016;134:1314–1324.