TY - JOUR
T1 - Perioperative and postoperative predictors of outcome in patients with low ejection fraction early after coronary artery bypass grafting
T2 - The additional value of left ventricular remodeling
AU - Temporelli, Pier Luigi
AU - Scapellato, Francesco
AU - Corrà, Ugo
AU - Pistono, Massimo
AU - Eleuteri, Ermanno
AU - Imparato, Alessandro
AU - Giannuzzi, Pantaleo
PY - 2008/8
Y1 - 2008/8
N2 - Background: Scant data exist on factors that may identify outcome in patients with severe left ventricular (LV) dysfunction early after coronary artery bypass graft surgery (CABG). Design: This study was designed to determine the prognostic value of clinical, operative, and postoperative factors in patients with LV dysfunction early after CABG. Methods: In 333 consecutive patients with ejection fraction ≤35% on admission to residential cardiac rehabilitation after isolated CABG, potential preoperative, perioperative, and postoperative predictors of outcome, including 6-month LV remodeling, were recorded and patients followed up for a median of 3 years. The study end points were cardiovascular (CV) mortality and the combination of CV mortality and nonfatal CV events requiring hospitalization. Results: The 3-year CV mortality-free survival and survival free of nonfatal CV event rates were 87 and 73%, respectively. Independent predictors of CV mortality were history of congestive heart failure [hazard ratio, HR: 2.8; 95% Confidence Interval (CI): 1.51-5.21], low ejection fraction on admission to cardiac rehabilitation (HR: 0.9; 95% CI: 0.87-0.96), and early complications after CABG (HR: 2.5; 95% CI: 1.23-5.15). When the combined end points were considered, postoperative left atrial size (HR: 1.07; 95% CI: 1.01-1.11), New York Heart Association class III or IV (HR: 1.69; 95% CI: 1.04-2.74), and 6-month remodeling (HR: 2.12; 95% CI: 1.33-3.36) were independent predictors. Conclusion: Simple preoperative and postoperative variables may help identify patients with LV dysfunction early after CABG who are still at risk of major CV events. In this setting, 6-month LV remodeling is a strong predictor of a poor prognosis.
AB - Background: Scant data exist on factors that may identify outcome in patients with severe left ventricular (LV) dysfunction early after coronary artery bypass graft surgery (CABG). Design: This study was designed to determine the prognostic value of clinical, operative, and postoperative factors in patients with LV dysfunction early after CABG. Methods: In 333 consecutive patients with ejection fraction ≤35% on admission to residential cardiac rehabilitation after isolated CABG, potential preoperative, perioperative, and postoperative predictors of outcome, including 6-month LV remodeling, were recorded and patients followed up for a median of 3 years. The study end points were cardiovascular (CV) mortality and the combination of CV mortality and nonfatal CV events requiring hospitalization. Results: The 3-year CV mortality-free survival and survival free of nonfatal CV event rates were 87 and 73%, respectively. Independent predictors of CV mortality were history of congestive heart failure [hazard ratio, HR: 2.8; 95% Confidence Interval (CI): 1.51-5.21], low ejection fraction on admission to cardiac rehabilitation (HR: 0.9; 95% CI: 0.87-0.96), and early complications after CABG (HR: 2.5; 95% CI: 1.23-5.15). When the combined end points were considered, postoperative left atrial size (HR: 1.07; 95% CI: 1.01-1.11), New York Heart Association class III or IV (HR: 1.69; 95% CI: 1.04-2.74), and 6-month remodeling (HR: 2.12; 95% CI: 1.33-3.36) were independent predictors. Conclusion: Simple preoperative and postoperative variables may help identify patients with LV dysfunction early after CABG who are still at risk of major CV events. In this setting, 6-month LV remodeling is a strong predictor of a poor prognosis.
KW - Cardiac rehabilitation
KW - Coronary artery bypass graft
KW - Left ventricular dysfunction
KW - Left ventricular remodeling
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U2 - 10.1097/HJR.0b013e3282f73501
DO - 10.1097/HJR.0b013e3282f73501
M3 - Article
C2 - 18677169
AN - SCOPUS:55249096748
VL - 15
SP - 441
EP - 447
JO - European Journal of Cardiovascular Prevention and Rehabilitation
JF - European Journal of Cardiovascular Prevention and Rehabilitation
SN - 1741-8267
IS - 4
ER -