Dikshya Joshi
Dikshya Joshi , Shahid Gangalal National Heart Center, Nepal
Title: Predictors of mortality in patients with Left Main Coronary artery disease undergoing coronary artery bypass grafting
Biography
Biography: Dikshya Joshi
Abstract
Introduction: Left Main Coronary Artery Disease (LMCAD) is associated with higher mortality in patients undergoing Coronary artery bypass grafting (CABG). We sought to review the predictors of mortality in LMCAD population who underwent CABG.
Methods: Hospital records of all consecutive patients who underwent CABG between April 2004 and August 2016 were evaluated in this retrospective study. Data regarding demographic profile, risk factors for coronary artery disease, functional class, left ventricular ejection fraction (LVEF), use of Intra-aortic Balloon Pump (IABP), complications, ICU stay, duration of mechanical ventilation and mortality were assessed.
Results: One hundred seventy patients underwent CABG for LMCAD during the study period. Mean age was 60.4±10 years, and 141(82%) were males. Mean Euroscore for our patients were 6.2±8.3. Mean number of vessels grafted were 3.2±0.9. IABP was used in 52(30.6%) patients perioperatively. The overall mortality was 22 (12.9% 95% CI 7.78-17.82%). Bivariate correlates of mortality were calculated and significant variables were included in multivariate analysis. Independent predictors of mortality were Age (OR 1.85 CI 1.6-2.1; p<0.01), LVEF<50% (OR 3.13 CI 1.26-7.8; p<0.01), and use of IABP, (OR 3.24 CI 1.3-8.08; p<0.008). Follow up was available for 70 patients with a mean duration of 32±2.2 months. Most of the patients are in CCS class I (80%). One of the patients required re-do CABG for graft occlusion 6 months after surgery.
Conclusion:Surgery for LMCAD has higher risk when performed at older age, lower LVEF and the requirement of IABP. However, requirement for reintervention remains low at intermediate follow-up.
Keywords: CABG, left main disease, LMCAD, surgery