Outcomes of coronary artery bypass grafting in patients with heart failure with a midrange ejection fraction |
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| Affiliation: | 1. Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio;2. Cleveland VA CV Research Group, Cleveland, Ohio;3. Department of Cardiovascular Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio;4. Department of Cardiovascular Medicine, Harrington Heart and Vascular Institute, Cleveland Medical Center, Cleveland, Ohio;5. Department of Cardiac Surgery, John Hopkins School of Medicine, Baltimore, Md;1. Division of Cardiac Surgery, Department of Surgery, SUNY Upstate Medical University, Syracuse, NY;2. Division of Cardiac Surgery, Department of Surgery, Adventist HealthCare, Silver Spring, Md;1. Cardiac Surgery Department, Instituto Cardiovascular, Buenos Aires, Argentina;2. Department of Cardiovascular Anesthesia, Instituto Cardiovascular, Buenos Aires, Argentina;3. Cardiovascular Intensive Care Unit, Instituto Cardiovascular, Buenos Aires, Argentina;1. Department of Cardiothoracic and Vascular Surgery, West Virginia University Medicine, Morgantown, WVa;2. Divisions of General and Cardiothoracic Surgery, Department of Surgery, Baylor College of Medicine, Houston, Tex;3. Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Md;4. Heart Consultants, Methodist Physicians Clinic, Omaha, Neb;5. Department of Cardiac Surgery, Yale School of Medicine, New Haven, Conn;6. Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Mich;7. Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada;1. Unit of Vascular Surgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico G. Martino, University of Messina, Messina, Italy;2. Division of Vascular Surgery and Endovascular Therapy, University of South California, Los Angeles, Calif;3. Division of Vascular Surgery, Heart Institute for Vascular Therapeutics, Cedars Sinai, Los Angeles, Calif;4. Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy;5. Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, Tex;6. Department of General and Vascular Surgery, Baylor Plano Heart Hospital, Plano, Tex;7. Department of Clinical and Community Sciences, Fondazione IRCCS Ca'' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy |
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| Abstract: | ![]()
BackgroundCoronary 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%).MethodsWe 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.ResultsIn 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]).ConclusionsHeart 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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