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Outcomes of coronary artery bypass grafting in patients with heart failure with a midrange ejection fraction.
Deo, Salil V; Sundaram, Varun; Sahadevan, Jayakumar; Selvaganesan, Padmini; Mohan, Srikrishna Madan; Rubelowsky, Joseph; Josephson, Richard; Elgudin, Yakov; Kilic, Ahmet; Cmolik, Brian.
Afiliación
  • Deo SV; Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio; Cleveland VA CV Research Group, Cleveland, Ohio. Electronic address: svd14@case.edu.
  • Sundaram V; Cleveland VA CV Research Group, Cleveland, Ohio; Department of Cardiovascular Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.
  • Sahadevan J; Cleveland VA CV Research Group, Cleveland, Ohio; Department of Cardiovascular Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.
  • Selvaganesan P; Department of Cardiovascular Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.
  • Mohan SM; Cleveland VA CV Research Group, Cleveland, Ohio.
  • Rubelowsky J; Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.
  • Josephson R; Cleveland VA CV Research Group, Cleveland, Ohio; Department of Cardiovascular Medicine, Harrington Heart and Vascular Institute, Cleveland Medical Center, Cleveland, Ohio.
  • Elgudin Y; Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.
  • Kilic A; Department of Cardiac Surgery, John Hopkins School of Medicine, Baltimore, Md.
  • Cmolik B; Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.
J Thorac Cardiovasc Surg ; 165(1): 149-158.e4, 2023 01.
Article en En | MEDLINE | ID: mdl-33618872
ABSTRACT

BACKGROUND:

Coronary artery bypass grafting (CABG) improves survival in patients with heart failure and severely reduced left ventricular systolic function (LVEF). Limited data exist regarding adverse cardiovascular event rates after CABG in patients with heart failure with midrange ejection fraction (HFmrEF; LVEF > 40% and < 55%).

METHODS:

We analyzed data on isolated CABG patients from the Veterans Affairs national database (2010-2019). We stratified patients into control (normal LVEF and no heart failure), HFmrEF, and heart failure with reduced LVEF (HFrEF) groups. We compared all-cause mortality and heart failure hospitalization rates between groups with a Cox model and recurrent events analysis, respectively.

RESULTS:

In 6533 veterans, HFmrEF and HFrEF was present in 1715 (26.3%) and 566 (8.6%) respectively; the control group had 4252 (65.1%) patients. HFrEF patients were more likely to have diabetes mellitus (59%), insulin therapy (36%), and previous myocardial infarction (31%). Anemia was more prevalent in patients with HFrEF (49%) as was a lower serum albumin (mean, 3.6 mg/dL). Compared with the control group, a higher risk of death was observed in the HFmrEF (hazard ratio [HR], 1.3 [1.2-1.5)] and HFrEF (HR, 1.5 [1.2-1.7]) groups. HFmrEF patients had the higher risk of myocardial infarction (subdistribution HR, 1.2 [1-1.6]; P = .04). Risk of heart failure hospitalization was higher in patients with HFmrEF (HR, 4.1 [3.5-4.7]) and patients with HFrEF (HR, 7.2 [6.2-8.5]).

CONCLUSIONS:

Heart failure with midrange ejection fraction negatively affects survival after CABG. These patients also experience higher rates myocardial infarction and heart failure hospitalization.
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Insuficiencia Cardíaca / Infarto del Miocardio Límite: Humans Idioma: En Revista: J Thorac Cardiovasc Surg Año: 2023 Tipo del documento: Article

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Insuficiencia Cardíaca / Infarto del Miocardio Límite: Humans Idioma: En Revista: J Thorac Cardiovasc Surg Año: 2023 Tipo del documento: Article