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Long-term results of coronary artery bypass grafting in patients with ischemic cardiomyopathy: the impact of renal insufficiency and noncardiac vascular disease.
- Source :
-
Journal of cardiac failure [J Card Fail] 2005 Apr; Vol. 11 (3), pp. 206-12. - Publication Year :
- 2005
-
Abstract
- Background: We examined outcomes of patients with ischemic cardiomyopathy (ICMP), defined by left ventricular ejection fraction (LVEF) <35%, compared with patients with better-preserved LVEF, undergoing coronary bypass graft surgery (CABG). In addition, we examined the relative impact of a reduced LVEF in comparison with other comorbidities on long-term mortality in these patients.<br />Methods and Results: We evaluated 1381 patients (114 with ICMP, 1267 with better-preserved LVEF) who underwent isolated CABG at a tertiary Veterans Administration (VA) hospital between 1990 and 2000 using data from the VA Continuous Improvement in Cardiac Surgery Program and other VA databases. The 5-year survival was 74.0% in patients with ICMP and 84.4% in the group with better-preserved LVEF ( p = .005). LVEF <35% remained a significant predictor of long-term mortality in multivariable models (hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.02-2.35). However, the presence of comorbidities, especially renal insufficiency, peripheral vascular disease, and cerebrovascular disease, had a similar or greater impact on long-term mortality. Renal insufficiency (serum creatinine >1.5 mg/dL) was associated with the highest risk of long-term mortality (HR 2.02, 95% CI 1.46-2.80). The use of a left internal thoracic artery graft reduced the risk of long-term mortality (HR 0.72, 95% CI 0.54-0.98).<br />Conclusion: Even though severely depressed LVEF is associated with an increased risk of long-term mortality, the presence of comorbid factors, especially renal dysfunction and noncardiac vascular disease, increase the risk of long-term mortality by a similar or even larger magnitude. These comorbid factors should be given important consideration when evaluating the risks and benefits of CABG.
- Subjects :
- Age Factors
Cardiomyopathies therapy
Cerebrovascular Disorders mortality
Cohort Studies
Diuretics therapeutic use
Female
Hospitals, Veterans
Humans
Male
Mammary Arteries transplantation
Middle Aged
Myocardial Ischemia therapy
Peripheral Vascular Diseases mortality
Pulmonary Disease, Chronic Obstructive mortality
Renal Insufficiency mortality
Retrospective Studies
Stroke Volume physiology
Survival Analysis
Texas epidemiology
Ventricular Dysfunction, Left physiopathology
Ventricular Dysfunction, Left therapy
Cardiomyopathies mortality
Coronary Artery Bypass
Myocardial Ischemia mortality
Ventricular Dysfunction, Left mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1071-9164
- Volume :
- 11
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of cardiac failure
- Publication Type :
- Academic Journal
- Accession number :
- 15812749
- Full Text :
- https://doi.org/10.1016/j.cardfail.2004.07.008