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Long-term outcome of surgical revascularization in patients with reduced left ventricular ejection fraction—a population-based cohort study
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 cardi...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9419690/ https://www.ncbi.nlm.nih.gov/pubmed/35445696 http://dx.doi.org/10.1093/icvts/ivac095 |
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author | Brynjarsdottir, Helga B Johnsen, Arni Heimisdottir, Alexandra A Heidarsdottir, Sunna Rún Jeppsson, Anders Sigurdsson, Martin I Gudbjartsson, Tomas |
author_facet | Brynjarsdottir, Helga B Johnsen, Arni Heimisdottir, Alexandra A Heidarsdottir, Sunna Rún Jeppsson, Anders Sigurdsson, Martin I Gudbjartsson, Tomas |
author_sort | Brynjarsdottir, Helga B |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-9419690 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-94196902022-08-29 Long-term outcome of surgical revascularization in patients with reduced left ventricular ejection fraction—a population-based cohort study Brynjarsdottir, Helga B Johnsen, Arni Heimisdottir, Alexandra A Heidarsdottir, Sunna Rún Jeppsson, Anders Sigurdsson, Martin I Gudbjartsson, Tomas Interact Cardiovasc Thorac Surg Adult Cardiac 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. Oxford University Press 2022-04-21 /pmc/articles/PMC9419690/ /pubmed/35445696 http://dx.doi.org/10.1093/icvts/ivac095 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Adult Cardiac Brynjarsdottir, Helga B Johnsen, Arni Heimisdottir, Alexandra A Heidarsdottir, Sunna Rún Jeppsson, Anders Sigurdsson, Martin I Gudbjartsson, Tomas 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 |
title_full | Long-term outcome of surgical revascularization in patients with reduced left ventricular ejection fraction—a population-based cohort study |
title_fullStr | Long-term outcome of surgical revascularization in patients with reduced left ventricular ejection fraction—a population-based cohort study |
title_full_unstemmed | Long-term outcome of surgical revascularization in patients with reduced left ventricular ejection fraction—a population-based cohort study |
title_short | Long-term outcome of surgical revascularization in patients with reduced left ventricular ejection fraction—a population-based cohort study |
title_sort | long-term outcome of surgical revascularization in patients with reduced left ventricular ejection fraction—a population-based cohort study |
topic | Adult Cardiac |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9419690/ https://www.ncbi.nlm.nih.gov/pubmed/35445696 http://dx.doi.org/10.1093/icvts/ivac095 |
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