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The Five and Ten Year Outcomes For Coronary Artery Bypass Graft (CABG) Surgery Patients Discharged Alive With Left Ventricular Dysfunction
V. Guru, S. E. Fremes, J. V. Tu. Institute For Clinical Evaluative Sciences, Toronto, ON, Canada,
Background: Past trial evidence suggests a mortality benefit with surgical revascularization in patients with left ventricular (LV) dysfunction. We provide new, long-term outcome data for CABG patients with LV dysfunction.
Methods: This was a retrospective, population based cohort study (n=64,550) using clinical and administrative data for patients discharged alive following isolated CABG in the province (fiscal years 1991-2002). The primary outcomes included cardiac readmission (UA, CHF, MI), and death. A multivariable Cox regression model compared the relative outcome by LV grade (Grade 1>=50% n=27,465 , Grade 2 35-49% n=23,718, Grade 3 20-34% n=10,940 , Grade 4 <20% n=2,427). Risk-adjusted survival curves by LV grade are provided (Figure 1).
Results: The higher the LV grade the higher the proportions of males, higher comorbidity, unstable angina at presentation, CHF, and previous bypass surgery. Table 1 provides the Cox HR by LV grade. Figure 1 shows the risk-adjusted survival curves by LV grade. Patients with a Grade 4 LV have a 20% higher 10 year mortality rate than those with a Grade 1 LV.
Conclusions: Patients with severe LV dysfunction (Grade 3 or 4 LV) have poor survival at 10 years following CABG. Adjunctive therapies such as stem cell transplantation may improve outcomes.
Cox Hazards Ratio (95% CI)| Outcome | Grade 2 LV (35-49%) | Grade 3 LV (20-34%) | Grade 4 LV (<20%) | | Cardiac Hospital Admission | 1.1 (1.03-1.10) | 1.3 (1.24-1.34) | 1.6 (1.54-1.75) | | Death | 1.2 (1.10-1.22) | 1.6 (1.55-1.75) | 2.4 (2.21-2.62) |
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