Perioperative and postoperative predictors of outcome in patients with low ejection fraction early after coronary artery bypass grafting: the additional value of left ventricular remodeling.
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).


METHODS
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 < or =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.


CONCLUSIONS
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.
Temporelli
Pier Luigi
PL
Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Veruno NO, Italy. pierluigi.temporelli@fsm.it
Scapellato
Francesco
F
Corrà
Ugo
U
Pistono
Massimo
M
Eleuteri
Ermanno
E
Imparato
Alessandro
A
Giannuzzi
Pantaleo
P
D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000534:rehabilitation; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013318:Stroke Volume; D016019:Survival Analysis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology; D020257:Ventricular Remodeling