Preoperative prediction of long-term survival after coronary artery bypass grafting in patients with low left ventricular ejection fraction (Journal article)

DeRose, J. J., Jr./ Toumpoulis, I. K./ Balaram, S. K./ Ioannidis, J. P./ Belsley, S./ Ashton, R. C., Jr./ Swistel, D. G./ Anagnostopoulos, C. E.


OBJECTIVE: We aimed to develop multivariable models of preoperative risk factors that predict long-term survival after coronary artery bypass grafting in patients with ejection fraction 25% or less. METHODS: We retrospectively evaluated 544 consecutive patients with ejection fraction 25% or less who underwent coronary artery bypass grafting from 1992 to 2002 at a single institution. Long-term survival data (mean follow-up 4.1 years) were obtained from the National Death Index. Multivariable Cox regression analysis was performed to construct a predictive score for long-term mortality. A split-sample approach was also used building a model on a training group (n = 360); this model was then tested on a separate validation group (n = 184). RESULTS: From the entire database, the predictive score was calculated according to the following equation: 0.430(if past congestive heart failure) + 0.049(age in years) + 0.507(if peripheral vascular disease) + 0.580(if emergency operation) + 0.366(if chronic obstructive pulmonary disease). The 5-year survivals of the predictive score quartiles were 82.3%, 78.2%, 65.5%, and 45.5% (P < .0001). The model based on the training group had four independent predictors for long-term mortality (the same as the listed equation except for past congestive heart failure). The 5-year survival rates of the quartiles were 90.1%, 75.4%, 64.3%, and 49.2% in the training group (P < .0001) and 77.4%, 71.2%, 65.8%, and 45.5% in the validation group (P = .0001). CONCLUSION: Coronary artery bypass grafting in patients with severe ischemic cardiomyopathy achieves satisfactory midterm and long-term survival in selected patients. This new score, which is based on long-term data from a large number of patients, may aid clinicians in selecting therapeutic interventions for patients with ischemic cardiomyopathy.
Institution and School/Department of submitter: Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής
Keywords: Aged,*Coronary Artery Bypass,Coronary Artery Disease/*mortality/*physiopathology/surgery,Female,Follow-Up Studies,Humans,Male,Middle Aged,Multivariate Analysis,New York/epidemiology,Postoperative Complications/etiology/mortality,Predictive Value of Tests,*Preoperative Care,Retrospective Studies,Stroke Volume/*physiology,Survival Analysis,Time Factors,Treatment Outcome,Ventricular Function, Left/*physiology
URI: http://olympias.lib.uoi.gr/jspui/handle/123456789/19122
ISSN: 0022-5223
Link: http://www.ncbi.nlm.nih.gov/pubmed/15678041
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