PMID- 10567289
OWN - NLM
STAT- MEDLINE
DCOM- 19991215
LR  - 20190623
IS  - 0009-7322 (Print)
IS  - 0009-7322 (Linking)
VI  - 100
IP  - 19 Suppl
DP  - 1999 Nov 9
TI  - Risk stratification for coronary bypass surgery in patients with left ventricular 
      dysfunction: analysis of the coronary artery bypass grafting patch trial 
      database.
PG  - II119-24
AB  - BACKGROUND: Preoperative characteristics may influence morbidity and mortality in 
      patients undergoing coronary artery bypass grafting (CABG). The CABG Patch Trial 
      was designed to assess the impact of prophylactic insertion of an implantable 
      cardioverter-defibrillator in patients undergoing high-risk CABG. This database 
      was used to investigate the influence of symptomatic congestive heart failure 
      (CHF) and angina on morbidity and mortality in CABG patients with ventricular 
      dysfunction. METHODS AND RESULTS: Data were analyzed for 900 randomized patients 
      with an ejection fraction </=35% and an abnormal signal-averaged ECG. 
      Single-variable and stepwise multiple logistic regression analyses were used for 
      mortality and length-of-stay (LOS) data. Severity of CHF and angina was graded by 
      the New York Heart Association (NYHA) and Canadian Cardiovascular Society (CCS) 
      classifications, respectively. Perioperative mortality was 3.5% in 454 patients 
      without clinical signs of heart failure versus 7.7% in 443 patients with NYHA 
      class I to IV heart failure (P=0.018). By multiple logistic regression analysis, 
      mortality was significantly higher in patients with preoperative symptomatic 
      (NYHA class I to IV) heart failure (odds ratio, 2.4; P=0.01) or reoperation (odds 
      ratio, 3.8; P<0.0001). Mortality was not significantly influenced by age, sex, 
      the presence or severity of angina, hypertension, left main coronary artery 
      disease, pulmonary disease, or severity of CHF (although LOS was increased 0.7 
      days per NYHA class). Patients with a history of stroke had a higher rate of 
      perioperative stroke (16.4% versus 3.6%, P=0.001) and an increased LOS (by 3.5 
      days). CONCLUSIONS: Symptomatic heart failure and reoperation are predictors of 
      increased operative mortality in patients with ventricular dysfunction and a 
      positive signal-averaged ECG. Conversely, patients without heart failure symptoms 
      may undergo CABG with relatively low mortality despite low ejection fraction. LOS 
      is prolonged significantly by advanced age, history of stroke, and the presence 
      and severity of heart failure.
FAU - Argenziano, M
AU  - Argenziano M
AD  - Department of Surgery, Columbia University College of Physicians and Surgeons, 
      New York, NY, USA. ma66@columbia.edu
FAU - Spotnitz, H M
AU  - Spotnitz HM
FAU - Whang, W
AU  - Whang W
FAU - Bigger, J T Jr
AU  - Bigger JT Jr
FAU - Parides, M
AU  - Parides M
FAU - Rose, E A
AU  - Rose EA
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
SB  - IM
MH  - Adult
MH  - Aged
MH  - *Coronary Artery Bypass/adverse effects
MH  - *Databases, Factual
MH  - Female
MH  - Heart Failure/mortality/*surgery
MH  - Humans
MH  - Intraoperative Complications
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Risk
MH  - Survival Analysis
MH  - Ventricular Dysfunction, Left/mortality/*surgery
EDAT- 1999/11/24 09:00
MHDA- 2001/03/28 10:01
CRDT- 1999/11/24 09:00
PHST- 1999/11/24 09:00 [pubmed]
PHST- 2001/03/28 10:01 [medline]
PHST- 1999/11/24 09:00 [entrez]
AID - 10.1161/01.cir.100.suppl_2.ii-119 [doi]
PST - ppublish
SO  - Circulation. 1999 Nov 9;100(19 Suppl):II119-24. doi: 
      10.1161/01.cir.100.suppl_2.ii-119.