Open Access Highly Accessed Research article

Preoperative ejection fraction as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population

Mohamed A Soliman Hamad1*, Albert HM van Straten1, Jacques PAM Schönberger1, Joost F ter Woorst1, Andre M de Wolf2, Elisabeth J Martens34 and André AJ van Zundert56

Author Affiliations

1 Department of Cardio-Thoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands

2 Department of Anesthesiology, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

3 Department of Education and Research, Catharina Hospital, Eindhoven, the Netherlands

4 Center of Research on Psychology in Somatic diseases, Department of Medical Psychology, Tilburg University, the Netherlands

5 Department of Anesthesiology, Catharina Hospital - Brabant Medical School, Eindhoven, the Netherlands

6 University Hospital Ghent, Ghent, Belgium

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Journal of Cardiothoracic Surgery 2010, 5:29  doi:10.1186/1749-8090-5-29

Published: 23 April 2010

Abstract

Background

Preoperative left ventricular dysfunction is an established risk factor for early and late mortality after revascularization. This retrospective analysis demonstrates the effects of preoperative ejection fraction on the short-term and long-term survival of patients after coronary artery bypass grafting.

Methods

Early and late mortality were determined retrospectively in 10 626 consecutive patients who underwent isolated coronary bypass between January 1998 and December 2007. The subjects were divided into 3 groups according to their preoperative ejection fraction. Expected survival was estimated by comparison with a general Dutch population group described in the database of the Dutch Central Bureau for Statistics. For each of our groups with a known preoperative ejection fraction, a general Dutch population group was matched for age, sex, and year of operation.

Results and Discussion

One hundred twenty-two patients were lost to follow-up. In 219 patients, the preoperative ejection fraction could not be retrieved. In the remaining patients (n = 10 285), the results of multivariate logistic regression and Cox regression analysis identified the ejection fraction as a predictor of early and late mortality. When we compared long-term survival and expected survival, we found a relatively poorer outcome in all subjects with an ejection fraction of < 50%. In subjects with a preoperative ejection fraction of > 50%, long-term survival exceeded expected survival.

Conclusions

The severity of left ventricular dysfunction was associated with poor survival. Compared with the survival of the matched general population, our coronary bypass patients had a worse outcome only if their preoperative ejection fraction was < 50%.