Thorac Cardiovasc Surg 2019; 67(S 01): S1-S100
DOI: 10.1055/s-0039-1678953
Short Presentations
Sunday, February 17, 2019
DGTHG: Auf den Punkt gebracht - Arrhythmie/Coronary
Georg Thieme Verlag KG Stuttgart · New York

Prevalence and Outcome of CABG in Patients with Severely Reduced Ejection Fraction

J.T. Demal
1   Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
,
B. Reiter
1   Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
,
D. Reichart
2   Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
,
M. Dalen
3   Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden
,
V. Ruggieri
4   Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France
,
G. Gatti
5   Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
,
F. Onorati
6   Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy
,
A. Rubino
7   Centro Clinico-Diagnostico “G.B. Morgagni,” Centro Cuore, Pedara, Italy
,
D. Maselli
8   Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy
,
R. Gherli
9   Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy
,
A. Salsano
10   Division of Cardiac Surgery, University of Genoa, Genoa, Italy
,
M. Saccocci
11   Department of Cardiac Surgery, University of Milan, Centro Cardiologico - Fondazione Monzino IRCCS, Milan, Italy
,
G. Santarpino
12   Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
,
N. Francesco
13   Division of Cardiac Surgery, University of Parma, Parma, Italy
,
M. De Feo
14   Department of Cardiothoracic Sciences, University of Campania “Luigi Vanvitelli,” Caserta, Italy
,
A. Perrotti
15   Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
,
G. Mariscalco
16   Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
,
F. Biancari
17   Turku University Hospital and Department of Surgery, University of Turku, Heart Center, Turku, Finland
› Author Affiliations
Further Information

Publication History

Publication Date:
28 January 2019 (online)

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Objectives: Although CABG has a beneficial effect on CV mortality in patients with heart failure,1 little data exist on the characteristics of this patient cohort. The aim of this study was to identify prevalence and outcome of patients with severely reduced ejection fraction undergoing isolated CABG.

Methods: A total of 7,350 consecutive patients who underwent isolated CABG from January 2015 to May 2017 were registered in the E-CABG database. This registry is a prospective, multicenter study that enrolled CABG patients at 16 European centers. Clinical and follow-up characteristics were compared between patients with an ejection fraction of ≤30% (group I) and patients with an ejection fraction of >30% (group II).

Results: Of 7,350 patients, 330 (4.5%) patients showed a severely reduced ejection fraction ≤30% in preoperative echocardiography (group I).

Patients of group I appeared with acute coronary syndrome (ACS) more frequently (67.9% [n = 224] vs. 49.3% [n = 3,458]; p < 0.00001). They presented in critical preoperative state more often (30.6% [n = 101] vs. 5.4% [n = 377]; p < 0.00001) and were treated as emergency procedure more frequently (14.2% [n = 47] vs. 4.3% [n = 301]; p < 0.00001).

Adjusted logistic regression analysis did not show significant differences between 30-day (group I: 6.4% [n = 21], group II: 1.8% [n = 124]; p = 0.916) or 1-year mortality (group I: 13.6% [n = 28], group II: 4.7% [n = 215]; p = 0.219) between group I and group II. However, the adjusted logistic regression analysis of the composite endpoint of postoperative acute kidney injury, stroke, myocardial infarction, and 1-year death was significantly more often reached in group I when compared to group II (46.5% [n = 93] vs. 29.6% [n = 1,330]; p = 0.032).

Conclusions: Patients with severely reduced ejection fraction more frequently present with ACS and show a more critical preoperative state when compared to patients with ejection fraction >30%. Even when adjusted for these divergent baseline parameters a severely reduced ejection fraction in CABG patients is associated with an impaired midterm outcome as these patients more frequently reach the composite endpoint.

1. Petrie MC, et al. Ten-year outcomes after coronary artery bypass grafting according to age in patients with heart failure and left ventricular systolic dysfunction clinical perspective: an analysis of the extended follow-up of the STICH Trial (Surgical Treatment for Ischemic Heart Failure). Circulation 2016;134:1314–1324.