title: Predictors of contemporary coronary artery bypass grafting outcomes.
abstract: OBJECTIVE
  The study objective was to identify the predictors of outcomes in a contemporary cohort of patients from the Reduction in cardiovascular Events by acaDesine in patients undergoing CABG (RED-CABG) trial. Despite the increasing risk profile of patients who undergo coronary artery bypass grafting, morbidity and mortality have remained low, and identification of the current predictors of adverse outcomes may permit new treatments to further improve outcomes.
  
  
  METHODS
  The RED-CABG trial was a multicenter, randomized, double-blind, placebo-controlled study that determined that acadesine did not reduce adverse events in moderately high-risk patients undergoing nonemergency coronary artery bypass grafting. The primary efficacy end point was a composite of all-cause death, nonfatal stroke, or the need for mechanical support for severe left ventricular dysfunction through postoperative day 28. Logistic regression modeling with stepwise variable selection identified which prespecified baseline characteristics were associated with the primary outcome. A second logistic model included intraoperative variables as potential covariates.
  
  
  RESULTS
  The 4 independent preoperative risk factors predictive of the composite end point were (1) a history of heart failure (odds ratio, 2.9); (2) increasing age (odds ratio, 1.033 per decade); (3) a history of peripheral vascular disease (odds ratio, 1.6); and (4) receiving aspirin before coronary artery bypass grafting (odds ratio, 0.5), which was protective. The duration of the cardiopulmonary bypass (odds ratio, 1.8) was the only intraoperative variable that contributed to adverse outcomes.
  
  
  CONCLUSIONS
  Patients who had heart failure and preserved systolic function had a similar high risk of adverse outcomes as those with low ejection fractions, and new approaches may mitigate this risk. Recognition of patients with excessive atherosclerotic burden may permit perioperative interventions to improve their outcomes. The contemporary risks of coronary artery bypass grafting have changed, and their identification may permit new methods to improve outcomes.
authors.affiliation: Division of Cardiac Surgery, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada. Electronic address: rweisel@uhnresearch.ca.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Weisel
authors.affiliation: Massachusetts General Hospital, Harvard University, Boston, Mass.
authors.forename: Nancy
authors.initials: N
authors.lastname: Nussmeier
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Newman
authors.affiliation: Stanford University School of Medicine, Palo Alto, Calif.
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Pearl
authors.affiliation: Drexel University College of Medicine, Philadelphia, Pa.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Wechsler
authors.affiliation: Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ambrosio
authors.affiliation: University of Michigan School of Medicine, Ann Arbor, Mich.
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Clare
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors.forename: Karen S
authors.initials: KS
authors.lastname: Pieper
authors.affiliation: New York Presbyterian - Columbia University Medical Center, New York, NY.
authors.forename: Linda
authors.initials: L
authors.lastname: Mongero
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors.forename: Tammy L
authors.initials: TL
authors.lastname: Reece
authors.affiliation: Division of Cardiac Surgery, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Terrence M
authors.initials: TM
authors.lastname: Yau
authors.affiliation: Division of Cardiac Surgery, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Fremes
authors.affiliation: Département de Chirurgie Cardiovasculaire, Assistance Publique - Hôpital Européen Georges Pompidou, Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Menasché
authors.affiliation: formerly with Merck Sharp & Dohme Corp, Whitehouse Station, NJ; now with Novartis, Basel, Switzerland.
authors.forename: Armando
authors.initials: A
authors.lastname: Lira
authors.affiliation: Stanford University School of Medicine, Palo Alto, Calif.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
authors.affiliation: East Carolina Heart Institute, Greenville, NC.
authors.forename: T Bruce
authors.initials: TB
authors.lastname: Ferguson
mesh_terms: D000367:Age Factors; D000620:Aminoimidazole Carboxamide / Q000031:analogs & derivatives / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000401:mortality; D002317:Cardiovascular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D004311:Double-Blind Method; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D058729:Peripheral Arterial Disease / Q000150:complications; D065840:Protective Factors; D012263:Ribonucleosides / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left
chemical_list: D002317:Cardiovascular Agents; D012263:Ribonucleosides; D000620:Aminoimidazole Carboxamide; C011651:acadesine; D001241:Aspirin