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J Thorac Cardiovasc Surg 2005;129:314-321
© 2005 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Preoperative prediction of long-term survival after coronary artery bypass grafting in patients with low left ventricular ejection fraction

^a College of Physicians and Surgeons of Columbia University, Department of Cardiothoracic Surgery, St Luke's–Roosevelt Hospital Center, New York, NY
^b Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
^c Institute for Clinical Research and Health Policy Studies, Department of Medicine, Tufts–New England Medical Center, Tufts University School of Medicine, Boston, Mass
^d Department of Cardiac Surgery, University of Athens School of Medicine, Attikon Hospital Center, Athens, Greece

Received for publication February 21, 2004; revisions received May 18, 2004; accepted for publication May 24, 2004.

^* Address for reprints: Joseph J. DeRose, Jr, MD, Department of Cardiothoracic Surgery, St Luke's–Roosevelt Hospital Center, 1111 Amsterdam Ave, MU217, New York, NY 10025 (E-mail: jjd11{at}columbia.edu).

OBJECTIVE: We aimed to develop multivariable models of preoperative risk factors that predict long-term survival after coronary artery bypass grafting in patients with ejection fraction 25% or less.

METHODS: We retrospectively evaluated 544 consecutive patients with ejection fraction 25% or less who underwent coronary artery bypass grafting from 1992 to 2002 at a single institution. Long-term survival data (mean follow-up 4.1 years) were obtained from the National Death Index. Multivariable Cox regression analysis was performed to construct a predictive score for long-term mortality. A split-sample approach was also used building a model on a training group (n = 360); this model was then tested on a separate validation group (n = 184).

RESULTS: From the entire database, the predictive score was calculated according to the following equation: 0.430(if past congestive heart failure) + 0.049(age in years) + 0.507(if peripheral vascular disease) + 0.580(if emergency operation) + 0.366(if chronic obstructive pulmonary disease). The 5-year survivals of the predictive score quartiles were 82.3%, 78.2%, 65.5%, and 45.5% (P < .0001). The model based on the training group had four independent predictors for long-term mortality (the same as the listed equation except for past congestive heart failure). The 5-year survival rates of the quartiles were 90.1%, 75.4%, 64.3%, and 49.2% in the training group (P < .0001) and 77.4%, 71.2%, 65.8%, and 45.5% in the validation group (P = .0001).

CONCLUSION: Coronary artery bypass grafting in patients with severe ischemic cardiomyopathy achieves satisfactory midterm and long-term survival in selected patients. This new score, which is based on long-term data from a large number of patients, may aid clinicians in selecting therapeutic interventions for patients with ischemic cardiomyopathy.

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