Predictors of major adverse outcomes in patients with stable coronary artery disease after coronary artery bypass grafting at three years follow-up
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Abstract
The aim – to establish predictors of late major adverse outcomes (MAOs) in patients (pts) with stable coronary artery disease (CAD) after coronary artery bypass grafting (CABG) at three years follow-up.
Material and methods. An observational single-center study included 251 consecutive pts with stable CAD (mean age (61±9) years, 218 (86.9 %) males, 33 (13.1 %) females), after isolated CABG. At three years follow-up, MAOs were registered: death – 11 (4.4 %) cases (among them – 9 cardiovascular death cases); myocardial infarction – 4 (1.6 %); unstable angina – 11 (4.4 %); stroke – 5 (2.0 %); heart failure (HF) decompensation – 20 (8.0 %); sustained ventricular tachycardia – 3 (1.6 %); repeated myocardial revascularization – 10 (4.0 %); peripheral artery embolism – 1 (0.4 %). In total, MAOs occurred in 55 (21.9 %) pts.
Results. At univariate analysis, MAOs were related to the following parameters: age; body mass index; HF IIB stage; permanent AF; estimated glomerular filtration rate (eGFR); left atrium antero-posterior dimension, indexed by body surface area (LAD/BSA); left ventricular (LV) end-diastolic volume index; aortic and mitral valve regurgitation; LV ejection fraction (EF); and early major postoperative complications. At multivariate analysis, the independent predictors of MAOs were following: worse LV systolic function at discharge (by LV EF grades (< 40 % vs 40–49 % vs ≥ 50 %):
odds ratio (OR) 2.145 (95 % confidence interval (CI) 1.382–3.329); Р=0,001); worse eGFR at baseline (per each
30 ml/(min • 1.73 m2) decrease vs ≥ 90 ml/(min • 1,73 m2): OR1.951 (95 % CI 1.112–3.421); Р=0.020) and larger
LAD/BSA (by degrees of enlargement: OR 1.918 (95 % CI 1.119–3.289); Р=0.018).
Conclusions. At three years follow-up, MAOs in pts with stable CAD after CABG were associated with worse baseline filtration kidney function, larger baseline LAD, and worse LV systolic function at discharge. Independent predictive value of baseline eGFR and LAD, and LV EF at discharge should be take into account while planning the postoperative follow-up schedule, as well as individualized prevention of late cardiovascular outcomes.
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References
Aksut B, Starling R, Kapadia S. Stable coronary artery disease and left ventricular dysfunction: The role of revascularization. Catheter Cardiovasc Interv. 2017 Nov 1;90(5):777–783. doi: 10.1002/ccd.27175.
Andersson B, She L, Tan RS, Jeemon P, Mokrzycki K, Siepe M, Romanov A, Favaloro LE, Djokovic LT, Raju PK, Betlejewski P, Racine N, Ostrzycki A, Nawarawong W, Das S, Rouleau JL, Sopko G, Lee KL, Velazquez EJ, Panza JA. The association between blood pressure and long-term outcomes of patients with ischaemic cardiomyopathy with and without surgical revascularization: an analysis of the STICH trial. Eur Heart J. 2018 Oct 1;39(37):3464-3471. doi: 10.1093/eurheartj/ehy438.
Basuray A, French B, Ky B, Vorovich E, Olt C, Sweitzer NK, Cappola TP, Fang JC. Heart failure with recovered ejection fraction: clinical description, biomarkers and outcomes. Circulation. 2014 Jun 10;129(23):2380-7. doi: 10.1161/CIRCULATIONAHA.113.006855..
Castelvecchio S, Ranucci M, Bandera F, Baryshnikova E, Giacomazzi F, Menicanti L. Surgical and Clinical Outcome Research (Score) Group The additional prognostic value of left atrial volume on the outcome of patients after surgical ventricular reconstruction. Ann. Thorac. Surg. 2013;95(1):141–147. doi: 10.1016/j.athoracsur.2012.08.024.
Chang M, Lee CW, Ahn JM, Cavalcante R, Sotomi Y, Onuma Y, Han M, Park SW, Serruys PW, Park SJ. Predictors of long-term outcomes after bypass grafting versus drug-eluting stent implantation for left main or multivessel coronary artery disease. Catheter Cardiovasc Interv. 2017 Aug 1;90(2):177-185. doi: 10.1002/ccd.26927
Cui KY, Lyu SZ, Song XT, Yuan F, Xu F, Zhang M, Zhang MD, Wang W, Zhang DF, Dai J, Tian JF, Wang YL. Long term outcomes of drug-eluting stent versus coronary artery bypass grafting for left main coronary artery disease: a meta-analysis. J. Geriatr. Cardiol. 2018;15(2):162–172. doi: 10.11909/j.issn.1671–5411.2018.02.009.
Dalén M, Lund LH, Ivert T, Holzmann MJ, Sartipy U. Survival After Coronary Artery Bypass Grafting in Patients With Preoperative Heart Failure and Preserved vs Reduced Ejection Fraction. JAMA Cardiol. 2016;1(5):530–538. doi: 10.1001/jamacardio.2016.1465.
Davierwala PM, Leontyev S, Garbade J, Lehmann S, Holzhey D, Misfeld M, Borger MA. Off-pump coronary artery bypass surgery with bilateral internal thoracic arteries: the Leipzig experience. Ann. Cardiothorac. Surg. 2018;7(4):483–491. doi: 10.21037/acs.2018.06.15.
Davierwala PM. Current outcomes of off-pump coronary artery bypass grafting: evidence from real world practice. J. Thorac. Dis. 2016;8(Suppl.10):S772–S786. doi: 10.21037/jtd.2016.10.102.
De Groote P, Fertin M, Duva Pentiah A, Goéminne C, Lamblin N, Bauters C. Long-term functional and clinical follow-up of patients with heart failure with recovered left ventricular ejection fraction after beta-blocker therapy. Circ Heart Fail. 2014;7:434–439. doi: 10.1161/CIRCHEARTFAILURE.113.000813.
Domoto S, Tagusari O, Nakamura Y, Takai H, Seike Y, Ito Y, Shibuya Y, Shikata F. Preoperative estimated glomerular filtration rate as a significant predictor of long-term outcomes after coronary artery bypass grafting in Japanese patients. Gen. Thorac. Cardiovasc. Surg. 2014;62(2):95–102. doi: 10.1007/s11748-013-0306-5.
Gatti G, Maschietto L, Dell'Angela L, Benussi B, Forti G, Dreas L, Soso P, Russo M, Sinagra G, Pappalardo A. Predictors of immediate and long-term outcomes of coronary bypass surgery in patients with left ventricular dysfunction. Heart Vessels 2016;31(7):1045–1055. doi: 10.1007/s00380-015-0714-9.
Gelsomino S, Del Pace S, Parise O, Caciolli S, Matteucci F, Fradella G, Bonacchi M, Fusco S, Lucà F, Marchionni N. Impact of renal function impairment assessed by CKDEPI estimated glomerular filtration rate on early and late outcomes after coronary artery bypass grafting. Int. J. Cardiol. 2017;227:778–787. doi: 10.1016/j.ijcard.2016.10.059.
Hickey GL, Grant SW, Cosgriff R, Dimarakis I, Pagano D, Kappetein AP, Bridgewater B. Clinical registries: governance, management, analysis and applications. Eur. J. Cardiothorac. Surg. 2013;44(4):605–614. doi: 10.1093/ejcts/ezt018.
Holzmann MJ, Gardell C, Jeppsson A, Sartipy U. Renal dysfunction and long-term risk of heart failure after coronary artery bypass grafting. Am. Heart J. 2013;166(1):142–149. doi: 10.1016/j.ahj.2013.03.005.
Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013;48(3):452–458. doi: 10.1038/bmt.2012.244.
Kangasniemi OP, Mahar MA, Rasinaho E, Satomaa A, Tiozzo V, Lepojärvi M, Biancari F. Impact of estimated glomerular filtration rate on the 15-year outcome after coronary artery bypass surgery. Eur. J. Cardiothorac. Surg. 2008;33(2):198–202. doi: 10.1016/j.ejcts.2007.11.002.
Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int. 2012;2:1–138. doi:10.1038/kisup.2012.1.
Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GY, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur. Heart J. 2016;37(38):2893–2962. doi: 10.1093/ejcts/ezw313.
Kulik A. Quality of life after coronary artery bypass graft surgery versus percutaneous coronary intervention: what do the trials tell us? Curr. Opin. Cardiol. 2017;32(6):707–714. doi: 10.1097/HCO.0000000000000458.
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J. Am. Soc. Echocardiogr. 2015;28(1):1–39.e14. doi: 10.1016/j.echo.2014.10.003.
Lazzeroni D, Gaibazzi N, Bini M, Bussolati G, Camaiora U, Cassi R, Geroldi S, Ugolotti PT, Brambilla L, Brambilla V, Castiglioni P, Coruzzi P. Prognostic value of new left atrial volume index severity partition cutoffs after cardiac rehabilitation program in patients undergoing cardiac surgery. Cardiovasc. Ultrasound. 2016;14(1):35. doi: 10.1186/s12947-016-0077-0. doi: 10.1186/s12947-016-0077-0.
Marui A, Okabayashi H, Komiya T, Tanaka S, Furukawa Y, Kita T, Kimura T, Sakata R; CREDO-Kyoto Investigators. Impact of occult renal impairment on early and late outcomes following coronary artery bypass grafting. Interact Cardiovasc Thorac Surg. 2013;17(4):638–643. doi: 10.1093/icvts/ivt254.
Nicolini F, Fortuna D, Contini GA, Pacini D, Gabbieri D, Zussa C, De Palma R, Vezzani A, Gherli T. The impact of age on clinical outcomes of coronary artery bypass grafting: long-term results of a real-world registry. Biomed. Res. Int. 2017;2017:9829487. doi: 10.1155/2017/9829487. Epub 2017 Dec 20.
Park DW, Ahn JM, Yun SC, Yoon YH, Kang DY, Lee PH, Lee SW, Park SW, Seung KB, Gwon HC, Jeong MH, Jang Y, Kim HS, Seong IW, Park HS, Ahn T, Chae IH, Tahk SJ, Park SJ. Ten-year outcomes of stents versus coronary-artery bypass grafting for left main coronary artery disease. J Am Coll Cardiol. 2018 Dec 11;72(23 Pt A):2813-2822. doi: 10.1016/j.jacc.2018.09.012.
Pieri M, Belletti A, Monaco F, Pisano A, Musu M, Dalessandro V, Monti G, Finco G, Zangrillo A, Landoni G. Outcome of cardiac surgery in patients with low preoperative ejection fraction. BMC. Anesthesiol. 2016;16(1):97. doi: 10.1186/s12871-016-0271-5.
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; Authors/Task Force Members; Document Reviewers. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur. J. Heart Fail. 2016;18(8):891–975. doi: 10.1002/ejhf.592.
Ram E, Goldenberg I, Kassif Y, Segev A, Lavee J, Einhorn-Cohen M, Raanani E. Real-life characteristics and outcomes of patients who undergo percutaneous coronary intervention versus coronary artery bypass grafting for left main coronary artery disease: data from the prospective Multi-vessel Coronary Artery Disease (MULTICAD) Israeli Registry. Eur. J. Cardiothorac. Surg. 2018;54(4):717–723. doi: 10.1093/ejcts/ezy115.
Rydén L, Sartipy U, Evans M, Holzmann MJ. Acute Kidney Injury After Coronary Artery Bypass Grafting and Long-Term Risk of End-Stage Renal Disease. Circulation. 2014;130(23):2005–2011. doi: 10.1161/CIRCULATIONAHA.114.010622.
Shiomi H, Yamaji K, Morimoto T, Shizuta S, Nakatsuma K, Higami H, Furukawa Y, Nakagawa Y, Kadota K, Ando K, Sakata R, Okabayashi H, Hanyu M, Shimamoto M, Nishiwaki N, Komiya T, Kimura T. Very long-term (10 to 14 year) outcomes after percutaneous coronary intervention versus coronary artery bypass grafting for multivessel coronary artery disease in the bare-metal stent era. Circ Cardiovasc Interv. 2016;9(8) pii: e003365. doi: 10.1161/CIRCINTERVENTIONS.115.003365.
Smart NA, Dieberg G, King N. Long-term outcomes of on- versus off-pump coronary artery bypass grafting. J. Am. Coll. Cardiol. 2018;71(9):983–91. doi: 10.1016/j.jacc.2017.12.049.
Sousa-Uva M, Head SJ, Milojevic M, Collet JP, Landoni G, Castella M, Dunning J, Gudbjartsson T, Linker NJ, Sandoval E, Thielmann M, Jeppsson A, Landmesser U. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery. Eur. J. Cardiothorac. Surg. 2018;53(1):5–33. doi: 10.1093/ejcts/ezx314.
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO; ESC Scientific Document Group. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019 Jan 7;40(2):87-165. doi: 10.1093/eurheartj/ehy394.
Su CS, Chen YW, Shen CH, Liu TJ, Chang Y, Lee WL. Clinical outcomes of left main coronary artery disease patients undergoing three different revascularization approaches. Medicine (Baltimore). 2018 Feb;97(7):e9778. doi: 10.1097/MD.
Sun LY, Tu JV, Bader Eddeen A, Liu PP. Prevalence and Long-Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction. J Am Heart Assoc. 2018 Jun 16;7(12). pii: e008902. doi: 10.1161/JAHA.118.008902.
Task Force Members, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabaté M, Senior R, Taggart DP, van der Wall EE, Vrints CJ; ESC Committee for Practice Guidelines, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S; Document Reviewers, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, Gonzalez-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Kristensen SD, Lancellotti P, Maggioni AP, Piepoli MF, Pries AR, Romeo F, Rydén L, Simoons ML, Sirnes PA, Steg PG, Timmis A, Wijns W, Windecker S, Yildirir A, Zamorano JL. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur. Heart J. 2013;34(38):2949–3003. doi: 10.1093/eurheartj/eht296.
Temporelli PL, Scapellato F, Corrà U, Pistono M, Eleuteri E, Imparato A, Giannuzzi P. 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. Eur. J. Cardiovasc. Prev. Rehabil. 2008;15(4):441–447. doi: 10.1097/HJR.0b013e3282f73501.
Wrobel K, Stevens SR, Jones RH, Selzman CH, Lamy A, Beaver TM, Djokovic LT, Wang N, Velazquez EJ, Sopko G, Kron IL, DiMaio JM, Michler RE, Lee KL, Yii M, Leng CY, Zembala M, Rouleau JL, Daly RC, Al-Khalidi HR. Influence of Baseline Characteristics, Operative Conduct and Postoperative Course on 30-day Outcomes of Coronary Artery Bypass Grafting among Patients with Left Ventricular Dysfunction: Results from the Surgical Treatment for Ischemic Heart Failure (STICH) Trial. Circulation. 2015;132(8):720–730. doi: 10.1161/CIRCULATIONAHA.114.014932.