Long-term results of coronary artery bypass grafting in patients with ischemic cardiomyopathy: the impact of renal insufficiency and noncardiac vascular disease.
BACKGROUND
We examined outcomes of patients with ischemic cardiomyopathy (ICMP), defined by left ventricular ejection fraction (LVEF) <35%, compared with patients with better-preserved LVEF, undergoing coronary bypass graft surgery (CABG). In addition, we examined the relative impact of a reduced LVEF in comparison with other comorbidities on long-term mortality in these patients.


RESULTS
We evaluated 1381 patients (114 with ICMP, 1267 with better-preserved LVEF) who underwent isolated CABG at a tertiary Veterans Administration (VA) hospital between 1990 and 2000 using data from the VA Continuous Improvement in Cardiac Surgery Program and other VA databases. The 5-year survival was 74.0% in patients with ICMP and 84.4% in the group with better-preserved LVEF ( p = .005). LVEF <35% remained a significant predictor of long-term mortality in multivariable models (hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.02-2.35). However, the presence of comorbidities, especially renal insufficiency, peripheral vascular disease, and cerebrovascular disease, had a similar or greater impact on long-term mortality. Renal insufficiency (serum creatinine >1.5 mg/dL) was associated with the highest risk of long-term mortality (HR 2.02, 95% CI 1.46-2.80). The use of a left internal thoracic artery graft reduced the risk of long-term mortality (HR 0.72, 95% CI 0.54-0.98).


CONCLUSIONS
Even though severely depressed LVEF is associated with an increased risk of long-term mortality, the presence of comorbid factors, especially renal dysfunction and noncardiac vascular disease, increase the risk of long-term mortality by a similar or even larger magnitude. These comorbid factors should be given important consideration when evaluating the risks and benefits of CABG.
Soltero
Ernesto R
ER
Section of Cardiothoracic Surgery, Operative Care Line, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Petersen
Nancy J
NJ
Earle
Nan R
NR
Glaeser
Donald H
DH
Urbauer
Diana L
DL
Deswal
Anita
A
D000367:Age Factors; D009202:Cardiomyopathies / Q000401:mortality* / Q000628:therapy; D002561:Cerebrovascular Disorders / Q000401:mortality; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality* / Q000628:therapy; D016491:Peripheral Vascular Diseases / Q000401:mortality; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality; D051437:Renal Insufficiency / Q000401:mortality; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D013781:Texas / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy
D004232:Diuretics