TITLE

The impact of diffuseness of coronary artery disease on the outcomes of patients undergoing primary and reoperative coronary artery bypass grafting

AUTHOR(S)
McNeil, Michael; Buth, Karen; Brydie, Alan; MacLaren, Angela; Baskett, Roger
PUB. DATE
May 2007
SOURCE
European Journal of Cardio-Thoracic Surgery;May2007, Vol. 31 Issue 5, p828
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Abstract: Objective: Diffuse coronary artery disease jeopardizes myocardium, increasing surgical mortality in primary coronary artery bypass grafting (CABG). We sought to determine the impact of diffuseness on pre- and post-discharge outcomes for both primary and reoperative CABG (REOP). Methods: Using a validated system for measuring diffuseness of coronary disease, preoperative angiograms were scored for primary CABG (n =792) and REOP cases (n =268) performed 1997–2004. A diffuseness score (DS)>18 was defined as elevated. In-hospital mortality, intermediate-term survival, and in-hospital composite outcome (COMP) (one or more of: mortality, stroke, MI, deep sternal infection, sepsis, IABP insertion, or return to OR) were examined. Results: In-hospital mortality and COMP for patients with DS>18 were significantly higher (7.9% vs 2.4%, p <0.0001), (17.8% vs 9.2%, p <0.0001). DS (mean±SD) was higher in REOP cases than primary CABG (18.9±7.1 vs 14.4±6.0, p <0.0001). By multivariate analysis, DS>18 (OR 2.00, 95%CI, 1.20–3.32, p =0.008) and REOP (OR 2.40, 95%CI, 1.53–3.77, p <0.0001) were independently associated with COMP. Using propensity scores 82% of cases with DS>18 (n =289) were matched 1:1 to cases with DS≤18. In-hospital mortality and COMP were significantly higher for cases with DS>18 (6.9% vs 2.8%, p =0.02), (16.6% vs 10.4%, p =0.03). Comparing cases with DS≤18 versus DS>18 and primary CABG versus REOP, survival at 2 years was 92.1% versus 84.5% (p =0.001) and 92.7% versus 82.7% (p <0.0001), respectively. Conclusions: Diffuse coronary artery disease is an important predictor of morbidity and mortality in primary and REOP CABG patients, and should be considered in both individual patient assessment and risk adjustment.
ACCESSION #
24611827

 

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