Survival and Independent Predictors of Mortality Following Coronary Artery Bypass Graft Surgery in a Single-Unit Practice in the United Kingdom Over 20 Years (original) (raw)
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Open Access Macedonian Journal of Medical Sciences, 2022
BACKGROUND: Various determinants of 30-day mortality risk in CABG patients have been formulated into certain scoring models such as the EuroSCORE and ACEF model. However, these models only consider pre-operative parameters while excluding intraoperative, post-operative, and perioperative parameters. At present, the prior research has increasingly emphasized the role of these excluded parameters as determinants of post-CABG mortality. Furthermore, there are differences in mortality rate of CABG procedures in Indonesia when compared with other countries. AIM: This study aimed to identify pre-operative, intraoperative, and post-operative determinants of 30-day mortality after CABG surgery in Indonesian population. METHODS: In this retrospective cohort study, secondary data were obtained from the medical records of 263 patients aged ≥ 18 years who underwent CABG at a single center in Indonesia during the year 2012-2015. Selected preoperative, intraoperative, post-operative, and perioperative determinants were analyzed in both bivariate and multivariate Cox regression models to identify determinants associated with 30-day mortality. RESULTS: The 30-day mortality rate after CABG was 11.8%. Multivariate analysis identified neurological dysfunction (HR 6.16; 95% CI 2.42-15.66), renal impairment (HR 3.9; 95% CI 1.46-10.38), left ventricle dysfunction (HR 3.53;95% CI 1.55-8.03), aortic clamp duration (HR 3.7;95% CI 1.53-8.96), surgery duration (HR 3.85;95% CI 1.39-10.70), post-operative thrombocytopenia (HR 3.99;95% CI 1.72-9.23), and post-operative intra-aortic balloon pump (HR 10.98; 95% CI 4.77-25.28) as significant determinants associated with 30-day mortality after CABG CONCLUSION: Neurological dysfunction, renal impairment, left ventricle dysfunction, aortic clamp duration, surgery duration, post-operative thrombocytopenia, and post-operative intra-aortic balloon pump were independent determinants for 30-day mortality after CABG.
Journal of Cardiology and Cardiovascular Sciences, 2020
Background: Coronary artery bypass grafting (CABG) is a major surgical intervention to relieve symptoms and promote survival for individuals with coronary heart disease (CHD). The benefits of the intervention are thought to be improved when underlying risk factors of CHD are ameliorated. However in current health care systems the long-term follow-up of patients following CABG is not centralized to allow for the determination of survival trends and their optimization. The survival of study participants who underwent CABG is compared with age and gender matched individuals from the general population. Differences in rates of survival are interpreted in terms of lifestyle choices and the impact of risk factors of CHD. Method: Survival data were obtained from government records to 18 years post intervention on a cohort of patients who underwent CABG and participated in a long-term follow-up program. Cardiac symptoms and risk factors of CHD were collected from consenting participants (44 women and 164 men) prior to CABG and at clinical assessments at one and eight-year follow-ups. Important clinical and lifestyle factors were identified and their impact on post-operative survival was quantified using a maximum likelihood technique. Male and female patients were investigated separately and a good fit between observed and simulated survival experiences was confirmed by Monte Carlo simulation. Results: Cardiac symptoms were exhibited by 75.8% of women and 68.3% of men (χ 2 =0.712, p=0.3988) one-year post operation, and by 84.2% of women and 70.2% of men eight-years post operation (χ 2 =1.556, p=0.212). Male longterm survival at 54.3% after 18 years was significantly better than 36.4% for females (χ 2 =4.449, p=0.035), but both were worse than 73.0% and 71.5% (p=0.6114) respectively for gender and age-matched cohorts from the general population. Important risk factors for women were post-operative smoking and postoperative hypertension reducing annual post-operative survival by 3.9% and 2.7% respectively and by 6.6% when both are present. Equivalent important risk factors for men are post-operative smoking and unrelieved/recurring cardiac symptoms reducing annual survival rates by 2.4% and 1.2% respectively and by 3.6% when both are present. Conclusion: Eighteen year survival post CABG was significantly better for men than women, but both were worse than that for the general population. Post-operative smoking was the most significant risk factor associated with decreased rates of survival followed by unrelieved/recurring cardiac symptoms for men and persisting hypertension for women.
Time-Varying Risk Factors for Long-Term Mortality After Coronary Artery Bypass Graft Surgery
The Annals of Thoracic Surgery, 2006
Background. There is a substantial literature on shortterm mortality risk factors for coronary artery bypass graft (CABG) surgery. However, very few studies have examined risk factors for long-term mortality. Methods. We analyzed 56,543 veterans who underwent CABG surgery at one of 43 VA cardiac surgery centers between October 1, 1991, and March 30, 2001. Each patient was followed for a minimum of 3.5 months and a maximum of 9.5 years for mortality assessment. The time-varying effects of 22 mortality preoperative risk factors were evaluated using both standard Cox regression models and Cox B-spline regression models. Results. Six variables showed significant varying effects over time on mortality after surgery. The effects of previous heart surgery or preoperative intra-aortic balloon pump carried about 5 times and 3 times the risk, respectively, of dying on the first day after surgery, but were not significant during long-term follow-up. Conversely, diabetes had little additional risk immediately after surgery, but the risk increased steadily and doubled at 9.5 years after surgery. Three other risk variables-age, chronic obstructive pulmonary disease, and urgent or emergent status-also had risk changing by 50% to 60% over the next decade. Most of the other 16 risk variables were significantly associated with mortality, but the risk did not vary substantially over time. Conclusions. Risk associated with some preoperative variables can change significantly during the decade after surgery, and risk assessments that assume constant risk during the postoperative period may substantially overestimate or underestimate risk at some times. These findings may help clinicians identify appropriate management strategies for patients during the years after CABG surgery, and support an emphasis on noncardiac comorbidities during later postoperative periods.
Circulation, 2003
Coronary artery bypass graft (CABG) surgery has been performed frequently for symptomatic coronary atherosclerotic heart disease for more than 30 years. However, uncertainty exists regarding the relationship between long-term survival after CABG and readily available clinical correlates of mortality. We studied outcome at 20 years by age, sex, and other variables in 3939 patients who had CABG surgery from 1973 to 1979 in the Emory University System of Healthcare. Twenty-year survival, freedom from myocardial infarction, and freedom from repeat CABG were 35.6% (95% confidence interval [CI], 33.9% to 37.3%), 66.6% (95% CI, 64.6% to 68.6%), and 59.1% (95% CI, 56.9% to 61.5%). Multivariate correlates of late mortality were age (hazard ratio [HR], 1.46 per 10 years), female sex (HR, 1.21), hypertension (HR, 1.44), angina class (HR, 1.07 per class increase of 1), prior CABG (HR, 1.72), ejection fraction (HR, 1.07 per 10-point decrease), number of vessels diseased (HR, 1.11 per 1-vessel increase), and weight (HR, 1.04 per 10 kg). Twenty-year survival by age was 55%, 38%, 22%, and 11% for age <50, 50 to 59, 60 to 69, and >70 years at the time of initial surgery. Survival at 20 years after surgery with and without hypertension was 27% and 41%, respectively. Similarly, 20-year survival was 37% and 29% for men and women. Symptomatic coronary atherosclerotic heart disease requiring surgical revascularization is progressive with continuing events and mortality. Clinical correlates of mortality significantly impact survival over time and may help identify long-term benefits after CABG.
Changes Over Time in Risk Profiles of Patients Who Undergo Coronary Artery Bypass Graft Surgery
JAMA Surgery, 2015
IMPORTANCE Today's coronary artery bypass grafting (CABG) population appears to comprise sicker patients than in the past; however, little is known about the change in the risk profile. OBJECTIVE To evaluate the change with time in the risk profile of patients who undergo CABG. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of records from the Veterans Affairs (VA) Surgical Quality Improvement Program (VASQIP); 65 097 patients who underwent isolated primary CABG from October 1, 1997, to April 30, 2011, were evaluated. MAIN OUTCOMES AND MEASURES Trends in risk profiles, surgical volume, and modern outcomes in the VA system. We determined the significance of changes in age and major comorbidities across time with simple linear regression analysis and evaluated the rates of perioperative mortality (30-day or in-hospital) and VASQIP predicted risk of mortality trends over time. RESULTS From 1997 to 2011, there were increases in mean (SD) patient age (63.1 [9.4] vs 64.3 [7. 8] years; R 2 = 0.34; P = .02) and body mass index (28.3 [5.1] vs 30.1 [5.8]; R 2 = 0.95). There were also increases in the prevalence of diabetes mellitus (32.8% vs 41.3%; R 2 = 0.82), preoperative New York Heart Association (NYHA) class III or IV heart failure status (14.3% vs 34.2%; R 2 = 0.74), and left main coronary artery disease (26.0% vs 32.8%; R 2 = 0.82) (all P < .001). There was a decrease in the prevalence of advanced angina severity (Canadian Cardiovascular Society class III or IV) (R 2 = 0.95), previous myocardial infarction (R 2 = 0.82), and low ejection fraction (Յ34%) (R 2 = 0.88) (all P< .05). There was no significant change in the prevalence of cerebrovascular and peripheral vascular disease, chronic obstructive pulmonary disease, or 3-vessel coronary artery disease. Perioperative mortality rates and the VASQIP predicted risk of mortality, respectively, decreased with time (3.2% and 3.1% vs 1.7% and 1.6%). From 2004 to 2011, there was a significant increase in the prevalence of previous percutaneous coronary intervention (18.6% to 29.2%; R 2 = 0.82; P = .002). Overall CABG volume decreased (5551 in 1998 vs 3857 in 2012; R 2 = 0.95; P< .001). CONCLUSIONS AND RELEVANCE From 1997 to 2011, there was a progressive increase in the prevalence of obesity, diabetes, left main coronary artery disease, and advanced NYHA heart failure class among VA patients undergoing CABG. The prevalence of previous myocardial infarction, low ejection fraction, and advanced angina decreased, perhaps because of earlier surgical referral, improvement in medical management, or a shift in patient selection for CABG. Operative mortality also decreased with time. These trends confirm the general perception of significant, ongoing improvement in the care of patients who undergo CABG in the VA, despite an older, sicker population.
Circulation, 2000
Background —The impact of percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) on long-term mortality rates in the presence of various demographic, clinical, and angiographic factors is uncertain in the population of patients suitable for both procedures. Methods and Results —In the Bypass Angioplasty Revascularization Investigation (BARI) randomized trial and registry, 3610 patients who were eligible to receive PTCA and CABG were revascularized between 1989 and 1992. Multivariate Cox models were used to identify factors associated with 5-year mortality and cardiac mortality, with particular attention to factors that interact with treatment. Diabetic patients receiving insulin had higher mortality and cardiac mortality rates with PTCA compared with CABG (relative risk [RR] 1.78 and 2.63, respectively, P <0.001), and patients with ST elevation had higher cardiac mortality rates with CABG than with PTCA (RR 4.08, P <0.001). Factors mos...