Early and Mid‐Term Outcomes of Patients Undergoing Coronary Artery Bypass Grafting in Ischemic Cardiomyopathy

Abstract

Background Many observational studies and trials have shown that coronary artery bypass grafting improves the survival in patients with ischemic cardiomyopathy. However, these results are based on data generated from developed countries. Poor socioeconomic statuses, lack of uniformity in healthcare delivery, differences in risk profile, and affordability to access optimal health care are some factors that make the conclusions from these studies irrelevant to patients from India. Methods and Results One‐hundred and sixty‐two patients with severe left ventricular dysfunction (ejection fraction ≤35%) who underwent coronary artery bypass grafting from 2009 to 2017 were enrolled for this study. Mean age of the study population was 58.67±9.70 years. Operative mortality was 11.62%. Thirty day/in‐house composite outcome of stroke and perioperative myocardial infarction were 5.8%. The percentage of survival for 1 year was 86.6%, and 5‐year survival was 79.9%. Five‐year event‐free survival was 49.3%. The mean ejection fraction improved from 30.7±4.08% (range 18–35) to 39.9±8.3% (range 24–60). Lack of improvement of left ventricular function was a strong predictor of late mortality (hazard ratio, 21.41; CI 4.33–105.95). Even though there was a trend towards better early outcome in off‐pump CABG , the 5‐year survival rates were similar in off‐pump and on‐pump group (73.4% and 78.9%, respectively; P value 0.356). Conclusions We showed that coronary artery bypass grafting in ischemic cardiomyopathy was associated with high early composite outcomes. However, the 5‐year survival rates were good. Lack of improvement of left ventricular function was a strong predictor of late mortality.

Midterm outcome of off‐pump CABG for severe LV dysfunction—Does LV size and function predict their midterm outcome?

“…The impact of change in EF after CABG for severe LV dysfunction is relatively well studied among the two, but the opinion is varied. While some studies point out that there is no relationship between worsening EF and long‐term mortality, Jose et al have found it to be a strong predictor of long‐term mortality and we concur with this finding 6,32 . Our midterm follow‐up analysis showed that an increase in LV dimension was associated with cardiac mortality ( p ≤ .0001) (Table 4).…”

“…Ours is one of the first few studies to investigate the midterm outcome of OP‐CABG in severe LV dysfunction in the Indian population 6,27 . Our midterm follow‐up was 97.4% complete.…”

“…Poor socioeconomic status, heavy colonization of organisms, and limited resources could also be attributed to a high incidence of septic complications. Jose et al also report similarly increased incidence of sepsis and operative mortality among CABG patients from the southern state of India 6 …”

“…Differences in disease pattern, late presentation, nonuniform availability of healthcare facilities, poor socioeconomic status of the majority of patients, and limited resources makes extrapolation of the established results to the Indian scenario less meaningful 5 . We have a paucity of data on the prognostic markers for this group of patients and the impact of change in ventricular function and size in the midterm is less studied 6 . With this background, we analyzed the immediate and midterm results of OP‐CABG for severe LV dysfunction of our institute.…”

Ejection Fraction Recovery after Coronary Artery Bypass Grafting for Ischemic Cardiomyopathy

“…10 Other research groups were able to find a significant LVEF improvement at 1, 6, and 12 months postoperatively, 7 9 12 13 while some others were able to find a significant LVEF improvement postoperatively, though no exact follow-up time point was specified. 4 5 6…”