Clinical and angiographic correlates of short- and long-term mortality in patients undergoing coronary artery bypass grafting.
Differences in the clinical and angiographic factors associated with short- and long-term outcomes in patients undergoing coronary artery bypass grafting (CABG) are less known. Accordingly, differences were examined in clinical and angiographic correlates of short- and long-term mortality after CABG in 8,229 patients undergoing initial CABG enrolled in the Duke Cardiovascular Disease Database (1995 to 2002). Logistic regression and Cox proportional hazard modeling were performed to determine independent correlates of 30-day and long-term mortality. Death occurred in 2.4% at 30 days and 17.6% beyond 30 days at a median follow-up of 6 years in patients who underwent CABG. Multivariable models identified older age, lower left ventricular ejection fraction, lower or higher body mass index, cerebrovascular disease, lack of internal mammary artery use, and lower cholesterol to be associated with increased risk of both events. Although hemodynamic status (preoperative myocardial infarction, New York Heart Association class, and cardiogenic shock), female gender, and minority race were associated with 30-day death; co-morbid conditions (serum creatinine, chronic lung disease, diabetes, previous heart failure, peripheral vascular disease, and left main disease) were associated with increased long-term (beyond 30 days) death (c indexes 0.76 and 0.79 for the short- and long-term mortality models, respectively). In conclusion, our study suggested that correlates of acute and long-term death were different in patients undergoing CABG. These differences should be kept in context when counseling patients undergoing CABG and may help facilitate targeted strategies to improve short- and long-term mortality risks after CABG.
Mehta
Rajendra H
RH
Duke Clinical Research Institute, Durham, North Carolina, USA. mehta007@dcri.duke.edu
Honeycutt
Emily
E
Shaw
Linda K
LK
Milano
Carmelo A
CA
Smith
Peter K
PK
Harrington
Robert A
RA
Sketch
Michael H
MH
D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D002784:Cholesterol / Q000097:blood; D015897:Comorbidity; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000401:mortality*; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D016016:Proportional Hazards Models; D044469:Racial Groups; D013318:Stroke Volume; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology
D002784:Cholesterol; D003404:Creatinine