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Long-term outcome of surgical revascularization in patients with reduced left ventricular ejection fraction-a population-based cohort study

Long-term outcome of surgical revascularization in patients with reduced left ventricular ejection fraction-a population-based cohort study


Title: Long-term outcome of surgical revascularization in patients with reduced left ventricular ejection fraction-a population-based cohort study
Author: Brynjarsdóttir, Helga B
Johnsen, Árni
Heimisdóttir, Alexandra A
Heiðarsdottir, Sunna Rún
Jeppsson, Anders
Sigurðsson, Martin Ingi
Guðbjartsson, Tómas
Date: 2022-08-03
Language: English
Scope:
University/Institute: Landspitali - The National University Hospital of Iceland
Department: Perioperative Services
Faculty of Medicine
Cardio-Vascular Center
Series: Interactive Cardiovascular and Thoracic Surgery; 35(3)
ISSN: 1569-9293
DOI: https://doi.org/10.1093/icvts/ivac095
Subject: Hjarta- og lungnaskurðlæknisfræði; Svæfinga- og gjörgæslulæknisfræði; Surgical revascularization; coronary artery bypass grafting (CABG); long term outcome; reduced left ventricular ejection fraction; risk factors; survival; Reduced left ventricular ejection fraction; Long-term outcome; Coronary artery bypass grafting; Survival; Risk factors; Ventricular Dysfunction, Left; Ventricular Function, Left; Humans; Treatment Outcome; Coronary Artery Disease; Stroke Volume; Retrospective Studies; Cohort Studies; Cardiology and Cardiovascular Medicine; Pulmonary and Respiratory Medicine; Surgery
URI: https://hdl.handle.net/20.500.11815/3243

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Citation:

Brynjarsdóttir , H B , Johnsen , Á , Heimisdóttir , A A , Heiðarsdottir , S R , Jeppsson , A , Sigurðsson , M I & Guðbjartsson , T 2022 , ' Long-term outcome of surgical revascularization in patients with reduced left ventricular ejection fraction-a population-based cohort study ' , Interactive Cardiovascular and Thoracic Surgery , vol. 35 , no. 3 . https://doi.org/10.1093/icvts/ivac095

Abstract:

OBJECTIVES: Surgical revascularization is an established indication for patients with advanced coronary artery disease and reduced left ventricular ejection fraction (LVEF). Long-term outcomes for these patients are not well-defined. We studied the long-term outcomes of patients with ischaemic cardiomyopathy who underwent surgical revascularization in a well-defined nationwide cohort. MATERIALS AND METHODS: A retrospective study on 2005 patients that underwent isolated coronary artery bypass grafting in Iceland between 2000 and 2016. Patients were categorized into two groups based on their preoperative LVEF; LVEF ≤35% (n = 146, median LVEF 30%) and LVEF >35% (n = 1859, median LVEF 60%). Demographics and major adverse cardiac and cerebrovascular events were compared between groups along with cardiac-specific and overall survival. The median follow-up was 7.6 years. RESULTS: Demographics were similar in both groups regarding age, gender and most cardiovascular risk factors. However, patients with LVEF ≤35% more often had diabetes, renal insufficiency, chronic obstructive pulmonary disease and a previous history of myocardial infarction. Thirty-day mortality was 4 times higher (8% vs 2%, P < 0.001) in the LVEF ≤35%-group compared to controls. Overall survival was significantly lower in the LVEF ≤35%-group compared to controls, at 1 year (87% vs. 98%, P < 0.001) and 5 years (69% vs. 91%, P < 0.001). In multivariable analysis LVEF ≤35% was linked to inferior survival with an adjusted hazard ratio of 2.0 (95%-CI 1.5 - 2.6, p<0.001). CONCLUSIONS: A good long-term outcome after coronary artery bypass grafting can be expected for patients with reduced LVEF, however, their survival is still significantly inferior to patients with normal ventricular function.

Description:

© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.

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