Long-term mortality after isolated coronary artery bypass grafting and risk factors for mortality
Background: Patients requiring coronary artery bypass grafting (CABG) have multiple co-morbidities which need to be considered in totality when determining surgical risks. The objective of this study is to evaluate short-term and long-term mortality rates of CABG surgery, as well as to identify the...
| Main Authors: | , , , , , , |
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| Other Authors: | |
| Format: | Journal Article |
| Language: | English |
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2024
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| Online Access: | https://hdl.handle.net/10356/181340 |
| _version_ | 1826116209706270720 |
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| author | Chua, Therese K. T. Gao, Fei Chia, Shaw Yang Sin, Kenny Y. K. Naik, Madhava J. Tan, Teing Ee Tham, Yi Chuan |
| author2 | Lee Kong Chian School of Medicine (LKCMedicine) |
| author_facet | Lee Kong Chian School of Medicine (LKCMedicine) Chua, Therese K. T. Gao, Fei Chia, Shaw Yang Sin, Kenny Y. K. Naik, Madhava J. Tan, Teing Ee Tham, Yi Chuan |
| author_sort | Chua, Therese K. T. |
| collection | NTU |
| description | Background: Patients requiring coronary artery bypass grafting (CABG) have multiple co-morbidities which need to be considered in totality when determining surgical risks. The objective of this study is to evaluate short-term and long-term mortality rates of CABG surgery, as well as to identify the most significant risk factors for mortality after isolated CABG. Methods: All patients with complete dataset who underwent isolated CABG between January 2008 and December 2017 were included. Univariate and multivariate Cox regression was performed to determine the risk factors for all-cause mortality. Classification and regression tree analysis was performed to identify the relative importance of these risk factors. Results: 3,573 patients were included in the study. Overall mortality rate was 25.7%. In-hospital mortality rate was 1.62% overall. 30-day, 1-year, 5-year, 10-year and 14.5-year mortality rates were 1.46%, 2.94%, 9.89%, 22.79% and 36.30% respectively. Factors associated with death after adjustment for other risk factors were older age, lower body mass index (BMI), hypertension, diabetes mellitus, chronic obstructive pulmonary disease, pre-operative renal failure on dialysis, higher last pre-operative creatinine level, lower estimated glomerular filtration rate (eGFR), heart failure, lower left ventricular ejection fraction and New York Heart Association class II, III and IV. Additionally, female gender and logistic EuroSCORE were associated with death on univariate Cox analysis, but not associated with death after adjustment with multivariate Cox analysis. Using CART analysis, the strongest predictor of mortality was pre-operative eGFR < 46.9, followed by logistic EuroSCORE ≥ 2.4. Conclusion: Poorer renal function, quantified by a lower eGFR, is the best predictor of post-CABG mortality. Amongst other risk factors, logistic EuroSCORE, age, diabetes and BMI had a relatively greater impact on mortality. Patients with chronic kidney disease stage 3B and above are at highest risk for mortality. We hope these findings heighten awareness to optimise current medical therapy in preserving renal function upon diagnosis of any atherosclerotic disease and risk factors contributing to coronary artery disease. |
| first_indexed | 2025-03-09T11:35:27Z |
| format | Journal Article |
| id | ntu-10356/181340 |
| institution | Nanyang Technological University |
| language | English |
| last_indexed | 2025-03-09T11:35:27Z |
| publishDate | 2024 |
| record_format | dspace |
| spelling | ntu-10356/1813402024-12-01T15:39:39Z Long-term mortality after isolated coronary artery bypass grafting and risk factors for mortality Chua, Therese K. T. Gao, Fei Chia, Shaw Yang Sin, Kenny Y. K. Naik, Madhava J. Tan, Teing Ee Tham, Yi Chuan Lee Kong Chian School of Medicine (LKCMedicine) Medicine, Health and Life Sciences Coronary artery bypass grafting Mortality Background: Patients requiring coronary artery bypass grafting (CABG) have multiple co-morbidities which need to be considered in totality when determining surgical risks. The objective of this study is to evaluate short-term and long-term mortality rates of CABG surgery, as well as to identify the most significant risk factors for mortality after isolated CABG. Methods: All patients with complete dataset who underwent isolated CABG between January 2008 and December 2017 were included. Univariate and multivariate Cox regression was performed to determine the risk factors for all-cause mortality. Classification and regression tree analysis was performed to identify the relative importance of these risk factors. Results: 3,573 patients were included in the study. Overall mortality rate was 25.7%. In-hospital mortality rate was 1.62% overall. 30-day, 1-year, 5-year, 10-year and 14.5-year mortality rates were 1.46%, 2.94%, 9.89%, 22.79% and 36.30% respectively. Factors associated with death after adjustment for other risk factors were older age, lower body mass index (BMI), hypertension, diabetes mellitus, chronic obstructive pulmonary disease, pre-operative renal failure on dialysis, higher last pre-operative creatinine level, lower estimated glomerular filtration rate (eGFR), heart failure, lower left ventricular ejection fraction and New York Heart Association class II, III and IV. Additionally, female gender and logistic EuroSCORE were associated with death on univariate Cox analysis, but not associated with death after adjustment with multivariate Cox analysis. Using CART analysis, the strongest predictor of mortality was pre-operative eGFR < 46.9, followed by logistic EuroSCORE ≥ 2.4. Conclusion: Poorer renal function, quantified by a lower eGFR, is the best predictor of post-CABG mortality. Amongst other risk factors, logistic EuroSCORE, age, diabetes and BMI had a relatively greater impact on mortality. Patients with chronic kidney disease stage 3B and above are at highest risk for mortality. We hope these findings heighten awareness to optimise current medical therapy in preserving renal function upon diagnosis of any atherosclerotic disease and risk factors contributing to coronary artery disease. Published version 2024-11-26T02:00:40Z 2024-11-26T02:00:40Z 2024 Journal Article Chua, T. K. T., Gao, F., Chia, S. Y., Sin, K. Y. K., Naik, M. J., Tan, T. E. & Tham, Y. C. (2024). Long-term mortality after isolated coronary artery bypass grafting and risk factors for mortality. Journal of Cardiothoracic Surgery, 19(1), 429-. https://dx.doi.org/10.1186/s13019-024-02943-0 1749-8090 https://hdl.handle.net/10356/181340 10.1186/s13019-024-02943-0 38987820 2-s2.0-85198089915 1 19 429 en Journal of Cardiothoracic Surgery © 2024 The Author(s). Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. application/pdf |
| spellingShingle | Medicine, Health and Life Sciences Coronary artery bypass grafting Mortality Chua, Therese K. T. Gao, Fei Chia, Shaw Yang Sin, Kenny Y. K. Naik, Madhava J. Tan, Teing Ee Tham, Yi Chuan Long-term mortality after isolated coronary artery bypass grafting and risk factors for mortality |
| title | Long-term mortality after isolated coronary artery bypass grafting and risk factors for mortality |
| title_full | Long-term mortality after isolated coronary artery bypass grafting and risk factors for mortality |
| title_fullStr | Long-term mortality after isolated coronary artery bypass grafting and risk factors for mortality |
| title_full_unstemmed | Long-term mortality after isolated coronary artery bypass grafting and risk factors for mortality |
| title_short | Long-term mortality after isolated coronary artery bypass grafting and risk factors for mortality |
| title_sort | long term mortality after isolated coronary artery bypass grafting and risk factors for mortality |
| topic | Medicine, Health and Life Sciences Coronary artery bypass grafting Mortality |
| url | https://hdl.handle.net/10356/181340 |
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