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(Circulation. 2004;110:II-13 – II-17.)
© 2004 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Long-Term Outcome of Isolated Coronary Artery Bypass Surgery in Patients With Severe Left Ventricular Dysfunction

Jehangir Appoo, MD; Colleen Norris, MSc PhD; Sabrina Merali; Michelle M. Graham, MD; Arvind Koshal, MD; Merril L. Knudtson, MD; William A. Ghali, MD MPH

From the Department of Surgery (J.A., S.M., A.K.), Faculty of Nursing (C.N.), and Department of Medicine (M.M.G.), University of Alberta, Edmonton, Canada; the Departments of Medicine (M.L.K., W.A.G.) and Community Health Sciences (W.A.G.), and the Centre for Health and Policy Studies, University of Calgary, Calgary, Alberta, Canada.

Correspondence to William A. Ghali, University of Calgary, Community Health Services Department, 3330 Hospital Drive North West, Calgary, Alberta, Canada T2N 4N1. E-mail wghali{at}ucalgary.ca

Background— Coronary artery bypass grafting (CABG) is indicated in patients with coronary artery disease and impaired ventricular function. However, earlier studies have suggested that prognosis of patients with severe left ventricular dysfunction is extremely poor. We used the APPROACH registry to derive contemporary estimates of prognosis associated with CABG for this high-risk patient population.

Methods and Results— The study group consisted of 7841 patients who had isolated CABG in the province of Alberta, Canada between 1996 and 2001. Patients with markedly reduced left ventricular function (ejection fraction [EF] <30%, Lo EF, n =430) were compared with those with moderate reduction in ventricular function (EF 30% to 50%, Med EF, n =2581) and those with normal left ventricular function (EF >50%, normal [Nl] EF, n=4830). The operative mortality was higher in the patient group with Lo EF (4.6%) compared with Med EF and Nl EF groups (3.4% and 1.9%, respectively, P<0.001). At 5 years, survival was 77.7% for Lo EF patients compared with 85.5% and 91.2% for Med EF and Nl EF patients, respectively (P<0.001). After controlling for other independent variables, the adjusted hazard ratio for death was 1.98 (95% CI, 1.49 to 2.62) for Lo EF relative to Nl EF. The mortality rate at 1 year was significantly lower for Lo EF patients who underwent CABG than it was for nonrevascularized Lo EF patients (risk-adjusted odds ratio, 0.36; 95% CI, 0.24 to 0.55).

Conclusions— In the modern era of cardiac surgery, CABG can be performed in Lo EF cases with an acceptable perioperative mortality risk. Our estimate of 5-year survival in this high-risk group is better than previously reported in the literature from earlier periods.

Key Words: coronary disease • heart failure • surgery • survival

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