Influence of baseline characteristics, operative conduct, and postoperative course on 30-day outcomes of coronary artery bypass grafting among patients with left ventricular dysfunction: Results from the Surgical Treatment for Ischemic Heart Failure (STICH) trial

Krzysztof Wrobel, Susanna R. Stevens, Robert H. Jones, Craig H. Selzman, Andre Lamy, Thomas M. Beaver, Ljubomir T. Djokovic, Nan Wang, Eric J. Velazquez, George Sopko, Irving L. Kron, J. Michael Dimaio, Robert E. Michler, Kerry L. Lee, Michael Yii, Chua Yeow Leng, Marian Zembala, Jean L. Rouleau, Richard C. Daly, Hussein R. Al-Khalidi

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background - Patients with severe left ventricular dysfunction, ischemic heart failure, and coronary artery disease suitable for coronary artery bypass grafting (CABG) are at higher risk for surgical morbidity and mortality. Paradoxically, those patients with the most severe coronary artery disease and ventricular dysfunction who derive the greatest clinical benefit from CABG are also at the greatest operative risk, which makes decision making regarding whether to proceed to surgery difficult in such patients. To better inform such decision making, we analyzed the Surgical Treatment for Ischemic Heart Failure (STICH) CABG population for detailed information on perioperative risk and outcomes. Methods and Results - In both STICH trials (hypotheses), 2136 patients with a left ventricular ejection fraction of ≤35% and coronary artery disease were allocated to medical therapy, CABG plus medical therapy, or CABG with surgical ventricular reconstruction. Relationships of baseline characteristics and operative conduct with morbidity and mortality at 30 days were evaluated. There were a total of 1460 patients randomized to and receiving surgery, and 346 (≈25%) of these high-risk patients developed a severe complication within 30 days. Worsening renal insufficiency, cardiac arrest with cardiopulmonary resuscitation, and ventricular arrhythmias were the most frequent complications and those most commonly associated with death. Mortality at 30 days was 5.1% and was generally preceded by a serious complication (65 of 74 deaths). Left ventricular size, renal dysfunction, advanced age, and atrial fibrillation/flutter were significant preoperative predictors of mortality within 30 days. Cardiopulmonary bypass time was the only independent surgical variable predictive of 30-day mortality. Conclusions - CABG can be performed with relatively low 30-day mortality in patients with left ventricular dysfunction. Serious postoperative complications occurred in nearly 1 in 4 patients and were associated with mortality.

Original languageEnglish (US)
Pages (from-to)720-730
Number of pages11
JournalCirculation
Volume132
Issue number8
DOIs
StatePublished - Aug 25 2015

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Left Ventricular Dysfunction
Coronary Artery Bypass
Heart Failure
Mortality
Coronary Artery Disease
Therapeutics
Decision Making
Morbidity
Ventricular Dysfunction
Atrial Flutter
Cardiopulmonary Resuscitation
Heart Arrest
Cardiopulmonary Bypass
Stroke Volume
Atrial Fibrillation
Renal Insufficiency
Cardiac Arrhythmias
Kidney
Population

Keywords

  • coronary artery disease
  • heart failure
  • myocardial revascularization
  • surgery

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Influence of baseline characteristics, operative conduct, and postoperative course on 30-day outcomes of coronary artery bypass grafting among patients with left ventricular dysfunction : Results from the Surgical Treatment for Ischemic Heart Failure (STICH) trial. / Wrobel, Krzysztof; Stevens, Susanna R.; Jones, Robert H.; Selzman, Craig H.; Lamy, Andre; Beaver, Thomas M.; Djokovic, Ljubomir T.; Wang, Nan; Velazquez, Eric J.; Sopko, George; Kron, Irving L.; Dimaio, J. Michael; Michler, Robert E.; Lee, Kerry L.; Yii, Michael; Leng, Chua Yeow; Zembala, Marian; Rouleau, Jean L.; Daly, Richard C.; Al-Khalidi, Hussein R.

In: Circulation, Vol. 132, No. 8, 25.08.2015, p. 720-730.

Research output: Contribution to journalArticle

Wrobel, K, Stevens, SR, Jones, RH, Selzman, CH, Lamy, A, Beaver, TM, Djokovic, LT, Wang, N, Velazquez, EJ, Sopko, G, Kron, IL, Dimaio, JM, Michler, RE, Lee, KL, Yii, M, Leng, CY, Zembala, M, Rouleau, JL, Daly, RC & Al-Khalidi, HR 2015, 'Influence of baseline characteristics, operative conduct, and postoperative course on 30-day outcomes of coronary artery bypass grafting among patients with left ventricular dysfunction: Results from the Surgical Treatment for Ischemic Heart Failure (STICH) trial', Circulation, vol. 132, no. 8, pp. 720-730. https://doi.org/10.1161/CIRCULATIONAHA.114.014932
Wrobel, Krzysztof ; Stevens, Susanna R. ; Jones, Robert H. ; Selzman, Craig H. ; Lamy, Andre ; Beaver, Thomas M. ; Djokovic, Ljubomir T. ; Wang, Nan ; Velazquez, Eric J. ; Sopko, George ; Kron, Irving L. ; Dimaio, J. Michael ; Michler, Robert E. ; Lee, Kerry L. ; Yii, Michael ; Leng, Chua Yeow ; Zembala, Marian ; Rouleau, Jean L. ; Daly, Richard C. ; Al-Khalidi, Hussein R. / Influence of baseline characteristics, operative conduct, and postoperative course on 30-day outcomes of coronary artery bypass grafting among patients with left ventricular dysfunction : Results from the Surgical Treatment for Ischemic Heart Failure (STICH) trial. In: Circulation. 2015 ; Vol. 132, No. 8. pp. 720-730.
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abstract = "Background - Patients with severe left ventricular dysfunction, ischemic heart failure, and coronary artery disease suitable for coronary artery bypass grafting (CABG) are at higher risk for surgical morbidity and mortality. Paradoxically, those patients with the most severe coronary artery disease and ventricular dysfunction who derive the greatest clinical benefit from CABG are also at the greatest operative risk, which makes decision making regarding whether to proceed to surgery difficult in such patients. To better inform such decision making, we analyzed the Surgical Treatment for Ischemic Heart Failure (STICH) CABG population for detailed information on perioperative risk and outcomes. Methods and Results - In both STICH trials (hypotheses), 2136 patients with a left ventricular ejection fraction of ≤35{\%} and coronary artery disease were allocated to medical therapy, CABG plus medical therapy, or CABG with surgical ventricular reconstruction. Relationships of baseline characteristics and operative conduct with morbidity and mortality at 30 days were evaluated. There were a total of 1460 patients randomized to and receiving surgery, and 346 (≈25{\%}) of these high-risk patients developed a severe complication within 30 days. Worsening renal insufficiency, cardiac arrest with cardiopulmonary resuscitation, and ventricular arrhythmias were the most frequent complications and those most commonly associated with death. Mortality at 30 days was 5.1{\%} and was generally preceded by a serious complication (65 of 74 deaths). Left ventricular size, renal dysfunction, advanced age, and atrial fibrillation/flutter were significant preoperative predictors of mortality within 30 days. Cardiopulmonary bypass time was the only independent surgical variable predictive of 30-day mortality. Conclusions - CABG can be performed with relatively low 30-day mortality in patients with left ventricular dysfunction. Serious postoperative complications occurred in nearly 1 in 4 patients and were associated with mortality.",
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T1 - Influence of baseline characteristics, operative conduct, and postoperative course on 30-day outcomes of coronary artery bypass grafting among patients with left ventricular dysfunction

T2 - Results from the Surgical Treatment for Ischemic Heart Failure (STICH) trial

AU - Wrobel, Krzysztof

AU - Stevens, Susanna R.

AU - Jones, Robert H.

AU - Selzman, Craig H.

AU - Lamy, Andre

AU - Beaver, Thomas M.

AU - Djokovic, Ljubomir T.

AU - Wang, Nan

AU - Velazquez, Eric J.

AU - Sopko, George

AU - Kron, Irving L.

AU - Dimaio, J. Michael

AU - Michler, Robert E.

AU - Lee, Kerry L.

AU - Yii, Michael

AU - Leng, Chua Yeow

AU - Zembala, Marian

AU - Rouleau, Jean L.

AU - Daly, Richard C.

AU - Al-Khalidi, Hussein R.

PY - 2015/8/25

Y1 - 2015/8/25

N2 - Background - Patients with severe left ventricular dysfunction, ischemic heart failure, and coronary artery disease suitable for coronary artery bypass grafting (CABG) are at higher risk for surgical morbidity and mortality. Paradoxically, those patients with the most severe coronary artery disease and ventricular dysfunction who derive the greatest clinical benefit from CABG are also at the greatest operative risk, which makes decision making regarding whether to proceed to surgery difficult in such patients. To better inform such decision making, we analyzed the Surgical Treatment for Ischemic Heart Failure (STICH) CABG population for detailed information on perioperative risk and outcomes. Methods and Results - In both STICH trials (hypotheses), 2136 patients with a left ventricular ejection fraction of ≤35% and coronary artery disease were allocated to medical therapy, CABG plus medical therapy, or CABG with surgical ventricular reconstruction. Relationships of baseline characteristics and operative conduct with morbidity and mortality at 30 days were evaluated. There were a total of 1460 patients randomized to and receiving surgery, and 346 (≈25%) of these high-risk patients developed a severe complication within 30 days. Worsening renal insufficiency, cardiac arrest with cardiopulmonary resuscitation, and ventricular arrhythmias were the most frequent complications and those most commonly associated with death. Mortality at 30 days was 5.1% and was generally preceded by a serious complication (65 of 74 deaths). Left ventricular size, renal dysfunction, advanced age, and atrial fibrillation/flutter were significant preoperative predictors of mortality within 30 days. Cardiopulmonary bypass time was the only independent surgical variable predictive of 30-day mortality. Conclusions - CABG can be performed with relatively low 30-day mortality in patients with left ventricular dysfunction. Serious postoperative complications occurred in nearly 1 in 4 patients and were associated with mortality.

AB - Background - Patients with severe left ventricular dysfunction, ischemic heart failure, and coronary artery disease suitable for coronary artery bypass grafting (CABG) are at higher risk for surgical morbidity and mortality. Paradoxically, those patients with the most severe coronary artery disease and ventricular dysfunction who derive the greatest clinical benefit from CABG are also at the greatest operative risk, which makes decision making regarding whether to proceed to surgery difficult in such patients. To better inform such decision making, we analyzed the Surgical Treatment for Ischemic Heart Failure (STICH) CABG population for detailed information on perioperative risk and outcomes. Methods and Results - In both STICH trials (hypotheses), 2136 patients with a left ventricular ejection fraction of ≤35% and coronary artery disease were allocated to medical therapy, CABG plus medical therapy, or CABG with surgical ventricular reconstruction. Relationships of baseline characteristics and operative conduct with morbidity and mortality at 30 days were evaluated. There were a total of 1460 patients randomized to and receiving surgery, and 346 (≈25%) of these high-risk patients developed a severe complication within 30 days. Worsening renal insufficiency, cardiac arrest with cardiopulmonary resuscitation, and ventricular arrhythmias were the most frequent complications and those most commonly associated with death. Mortality at 30 days was 5.1% and was generally preceded by a serious complication (65 of 74 deaths). Left ventricular size, renal dysfunction, advanced age, and atrial fibrillation/flutter were significant preoperative predictors of mortality within 30 days. Cardiopulmonary bypass time was the only independent surgical variable predictive of 30-day mortality. Conclusions - CABG can be performed with relatively low 30-day mortality in patients with left ventricular dysfunction. Serious postoperative complications occurred in nearly 1 in 4 patients and were associated with mortality.

KW - coronary artery disease

KW - heart failure

KW - myocardial revascularization

KW - surgery

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