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History of HF, regardless of EF, risk factor for poor CABG outcomes
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Regardless of preoperative ejection fraction, history of HF is an independent risk factor for poor short-term and long-term outcomes after CABG, according to data published in JAMA Cardiology.
Researchers analyzed 41,906 patients (mean age, 67 years; 21% women) from the SWEDEHEART registry who underwent primary isolated CABG in Sweden between 2001 and 2013 to discover whether EF played a role in survival outcomes. Patients were categorized as having no HF and preserved EF, no HF with reduced EF, HF with preserved EF (HFpEF) or HF with reduced EF (HFrEF).
During a median follow-up of 6.1 years, 19% of the patients died. Among those who did not survive, 13.2% had no HF and preserved EF, 24.6% had no HF with reduced EF, 33.9% had HFpEF and 42.9% had HFrEF, according to the researchers.
One-year survival rates were as follows: no HF with preserved EF, 98.2%; no HF with reduced EF, 94.6%; HFpEF, 94.1%; and HFrEF, 91.1%. The 5-year survival rates were 92.3%, 84%, 78.5% and 70.5%, respectively.
The researchers wrote that compared with patients with no HF and preserved EF, those with no HF and reduced EF (adjusted HR = 1.47; 95% CI, 1.4-1.56), those with HFpEF (adjusted HR = 1.62; 95% CI, 1.46-1.8) and those with HFpEF (adjusted HR = 2.29; 95%CI, 2.14-2.44) were at increased risk for all-cause mortality. The results were similar for all-cause mortality or HF-related readmission.
After the researchers adjusted for EF, HF was strongly associated with mortality (HR = 1.45; 95% CI, 1.37-1.54).
All-cause mortality at 30 days after surgery was 0.8% in patients with no HF with preserved EF, 2.9% in patients with no HF and reduced EF, 2.8% in patients with HFpEF and 4% in patients with HFrEF. According to the researchers, after multivariable adjustment, compared with patients with no HF and preserved EF, those with no HF and reduced EF (adjusted HR = 2.25; 95% CI, 1.86-2.73), those with HFpEF (adjusted HR = 1.83; 95% CI, 1.26-2.66) and those with HFrEF (adjusted HR = 2.52; 95% CI, 1.99-3.19) were at increased risk for 30-day mortality after CABG.
“While EF adds prognostic information in preoperative risk stratification, the HF syndrome may be a stronger predictor of long-term outcomes and should be carefully considered in preoperative assessment and postoperative follow-up,” the researchers wrote. – by Tracey Romero
Disclosure: The researchers report no relevant financial disclosures.
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