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Prognostic Significance of Positive Family History in Outcomes After Coronary Artery Bypass Grafting: Do We Need to Update Our Assumptions? Publisher Pubmed



Tavolinejad H1, 2, 3 ; Rashedi S1, 2, 3 ; Mojtaba Ghorashi S1 ; Tajdini M1 ; Sadeghian S1 ; Pashang M1 ; Jalali A1 ; Salehi Omran A1 ; Bagheri J1 ; Karimi A1 ; Shirzad M1 ; Mehrani M1 ; Hosseini K1, 3
Authors
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Authors Affiliations
  1. 1. Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran

Source: Journal of Cardiothoracic Surgery Published:2022


Abstract

Background: Recent research suggests a protective role for positive family history of premature cardiovascular disease (FHpCVD) in patients undergoing coronary artery bypass grafting. We aimed to further investigate this unlikely association. Methods: In this registry-based cohort study, patients who underwent first-time non-emergent coronary bypass surgery at Tehran Heart Center between 2007 and 2016 were included. Patients with and without FHpCVD were compared in terms of all-cause mortality and first non-fatal cardiovascular events (CVEs) comprising non-fatal acute coronary syndrome, non-fatal stroke or transient ischemic attack, and repeat coronary revascularization. Results: A total of 13,156 patients were included (mean age 60.83 ± 9.57, 74.5% male), among which 2684 (20.4%) patients had FHpCVD. Median follow-up was 77.7 months. FHpCVD was weakly associated with reduced all-cause mortality using inverse probability weight (IPW) method (hazard ratio [HR] = 0.853; 95% confidence interval [CI] 0.730–0.997; P = 0.046), and not associated with non-fatal CVEs considering death as the competing event (sub-distribution HR [SHR] = 1.124; 95% CI 0.999–1.265; P = 0.053). Within a subgroup of patients without previous myocardial infarction or revascularization (7403 cases; 56.3%), FHpCVD was associated with lower mortality (HR = 0.700; 95% CI 0.548–0.894; P = 0.004) and higher non-fatal CVEs (SHR = 1.197; 95% CI 1.019–1.405; P = 0.028), whereas among patients with previous coronary events, there was no association between FHpCVD and outcomes. Conclusions: FHpCVD was associated with lower all-cause mortality but higher non-fatal CVEs, especially in those without prior coronary events. Such discordance calls for caution in assuming a protective role for FHpCVD. The prognostic significance of FHpCVD needs further evaluation among surgical patients. © 2022, The Author(s).