Abstract 1817: Diffuse Coronary Artery Disease Predicts Poorer Outcomes after Primary and Re-Operative Coronary Artery Bypass Grafting
OBJECTIVES: Diffuse coronary artery disease is known to be a predictor of poor outcomes in patients with ischemic heart disease. It is believed to impact the results of coronary artery bypass grafting (CABG) but has not been properly studied, particularly in re-operative cases. We sought to determine the impact of diffuseness on pre- and post-discharge outcomes for both primary and re-operative CABG (REOP).
METHODS: Using a validated system for measuring diffuseness of coronary disease, pre-operative angiograms were scored for primary CABG (n = 792) and REOP cases (n = 268) performed between 1997 and 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, intra-aortic balloon pump insertion, or return to OR) were examined. Logistic regression, propensity score analysis and Kaplan-Meier survival analysis were used.
RESULTS: Crude 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 vs. DS ≤ 18, survival at 2 years was 92.1% vs. 84.5% (log rank p = 0.001).
CONCLUSIONS: Diffuse coronary artery disease is an important independent predictor of morbidity and mortality in primary and REOP CABG patients. Diffuseness of disease needs to be considered in both individual patient assessment and risk adjustment.