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Significance of Preoperative Left Ventricular Ejection Fraction in 5-Year Outcome After Isolated Cabg Publisher Pubmed



Fallahzadeh A1 ; Sheikhy A1 ; Ajam A2 ; Sadeghian S3 ; Pashang M4 ; Shirzad M5 ; Bagheri J5 ; Mansourian S5 ; Momtahen S5 ; Hosseini K3
Authors
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Authors Affiliations
  1. 1. Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, North Karegar Ave, PO Box: 1411713138, Tehran, Iran
  4. 4. Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Department of Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran

Source: Journal of Cardiothoracic Surgery Published:2021


Abstract

Background: Pre-operative ejection fraction (EF) and comorbidities affect post-op outcomes. We aimed to compare the mortality and adverse events of patients with different baseline EF and also to evaluate the distribution of comorbidities in each EF group. Methods: A total of 20,937 patients who underwent isolated coronary artery bypass graft (CABG) surgery from January 2006 to December 2016 was included. Patients were divided into three groups based on their pre-operative left ventricular EF as follows; (1) Normal: EF ≥ 50%; (2) Mild to moderately reduced: 50% < EF ≤ 35%; and (3) Severely reduced: EF < 35%. The backward elimination method was considered for multivariate Cox-regression analysis to locate predictors of mortality and non-fatal cerebro-cardiovascular events (CCVEs). The median follow-up time was 5.61 [3.12–8.0] years. Results: The mean age in the total population was 60.94 ± 9.51 years and 73.6% of the total population was male. Diabetes mellitus was the common risk factor of mortality and CCVE in all EF groups. Impaired renal function (GFR < 60 ml/min) was associated with a higher risk of mortality after CABG regardless of EF level. The median 5-year mortality rate in patients with normal EF, mild-moderately reduced EF and severely reduced EF were 9.5%, 12.8%, and 22.7% respectively (P < 0.001). Although the trend of CCVEs was higher in severe left ventricle (LV) dysfunction, it was not statistically significant (p = 0.071). Conclusion: Patients with severely reduced EF are at higher risk of mortality after CABG compared to those with higher EF levels; however, the rate of CCVEs may not be necessarily higher after adjustment for multiple pre-operative comorbidities. © 2021, The Author(s).
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