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Predictors of contemporary coronary artery bypass grafting outcomes
Journal article   Open access   Peer reviewed

Predictors of contemporary coronary artery bypass grafting outcomes

Richard D Weisel, Nancy Nussmeier, Mark F Newman, Ronald G Pearl, Andrew S Wechsler, Giuseppe Ambrosio, Bertram Pitt, Robert M Clare, Karen S Pieper, Linda Mongero, …
The Journal of thoracic and cardiovascular surgery, v 148(6), pp 2720-2726.e2
Dec 2014
DOI: https://doi.org/10.1016/j.jtcvs.2014.08.018
PMID: 25218533
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1016/j.jtcvs.2014.08.018View
Published, Version of Record (VoR)Open Access (Publisher-Specific),  Open

Abstract

Age Factors Aminoimidazole Carboxamide - analogs & derivatives Aminoimidazole Carboxamide - therapeutic use Aspirin - therapeutic use Cardiopulmonary Bypass - adverse effects Cardiopulmonary Bypass - mortality Cardiovascular Agents - therapeutic use Chi-Square Distribution Coronary Artery Bypass - adverse effects Coronary Artery Bypass - mortality Double-Blind Method Heart Failure - complications Heart Failure - physiopathology Humans Logistic Models Multivariate Analysis Odds Ratio Patient Selection Peripheral Arterial Disease - complications Protective Factors Ribonucleosides - therapeutic use Risk Assessment Risk Factors Stroke - etiology Stroke Volume Time Factors Treatment Outcome Ventricular Dysfunction, Left - etiology Ventricular Dysfunction, Left - physiopathology Ventricular Dysfunction, Left - therapy Ventricular Function, Left
The study objective was to identify the predictors of outcomes in a contemporary cohort of patients from the Reduction in cardiovascular Events by acaDesine in patients undergoing CABG (RED-CABG) trial. Despite the increasing risk profile of patients who undergo coronary artery bypass grafting, morbidity and mortality have remained low, and identification of the current predictors of adverse outcomes may permit new treatments to further improve outcomes. The RED-CABG trial was a multicenter, randomized, double-blind, placebo-controlled study that determined that acadesine did not reduce adverse events in moderately high-risk patients undergoing nonemergency coronary artery bypass grafting. The primary efficacy end point was a composite of all-cause death, nonfatal stroke, or the need for mechanical support for severe left ventricular dysfunction through postoperative day 28. Logistic regression modeling with stepwise variable selection identified which prespecified baseline characteristics were associated with the primary outcome. A second logistic model included intraoperative variables as potential covariates. The 4 independent preoperative risk factors predictive of the composite end point were (1) a history of heart failure (odds ratio, 2.9); (2) increasing age (odds ratio, 1.033 per decade); (3) a history of peripheral vascular disease (odds ratio, 1.6); and (4) receiving aspirin before coronary artery bypass grafting (odds ratio, 0.5), which was protective. The duration of the cardiopulmonary bypass (odds ratio, 1.8) was the only intraoperative variable that contributed to adverse outcomes. Patients who had heart failure and preserved systolic function had a similar high risk of adverse outcomes as those with low ejection fractions, and new approaches may mitigate this risk. Recognition of patients with excessive atherosclerotic burden may permit perioperative interventions to improve their outcomes. The contemporary risks of coronary artery bypass grafting have changed, and their identification may permit new methods to improve outcomes.

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Collaboration types
Industry collaboration
Domestic collaboration
International collaboration
Web of Science research areas
Cardiac & Cardiovascular Systems
Respiratory System
Surgery
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