Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden2Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden4Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
JAMA Cardiol. 2016 Aug 1;1(5):530-8. doi: 10.1001/jamacardio.2016.1465.
Data on the prognostic consequence of heart failure (HF) with preserved ejection fraction in patients undergoing coronary artery bypass grafting (CABG) are limited and inconclusive.
To investigate the survival after CABG in patients with preoperative HF and preserved ejection fraction (pEF) vs reduced ejection fraction (rEF).
DESIGN, SETTING, AND PARTICIPANTS: Swedish nationwide population-based cohort study that included all patients who underwent primary isolated CABG between January 1, 2001, and December 31, 2013, from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) register, with follow-up for all-cause mortality in March 2014. Information regarding baseline characteristics, all-cause mortality, and readmissions for HF was obtained from national health data registers. Preserved EF was defined as at least 50%.
The primary outcome was all-cause mortality. A secondary outcome measure was a combination of all-cause mortality and readmission for HF.
The study included 41 906 patients, 37 234 without known HF (27 165 with pEF and 10 069 with rEF) and 4672 with HF (1216 with pEF and 3456 with rEF). Their mean (SD) age was 67.4 (9.3) years, and 21.0% were female. During a mean (SD) follow-up time of 6.0 (3.3) years, 19.0% (7943 of 41 906) of patients died, including 13.2% (3574 of 27 165) with no HF and pEF, 24.6% (2476 of 10 069) with no HF and rEF, 33.9% (412 of 1216) with HFpEF, and 42.9% (1481 of 3456) with HFrEF. The multivariable-adjusted hazard ratios for death were 1.47 (95% CI, 1.40-1.56), 1.62 (95% CI, 1.46-1.80), and 2.29 (95% CI, 2.14-2.44) in patients with no HF and rEF, patients with HFpEF, and patients with HFrEF compared with patients with no HF and pEF. The findings were similar for the combined outcome of all-cause mortality and readmission for HF. The multivariable-adjusted hazard ratios for death within 30 days of surgery were 2.25 (95% CI, 1.86-2.73), 1.83 (95% CI, 1.26-2.66), and 2.52 (95% CI, 1.99-3.19) in patients with no HF and rEF, patients with HFpEF, and patients with HFrEF.
A history of HF was an important risk factor for poor short-term and long-term outcomes after CABG regardless of preoperative EF. Reduced EF more than doubled the risk of early death after CABG.
在接受冠状动脉旁路移植术 (CABG) 的患者中，心力衰竭 (HF) 合并射血分数保留的数据有限且尚无定论。
研究术前 HF 合并射血分数保留 (pEF) 与射血分数降低 (rEF) 的患者接受 CABG 后的生存情况。
设计、设置和参与者：这是一项基于人群的全国性瑞典队列研究，纳入了 2001 年 1 月 1 日至 2013 年 12 月 31 日期间在瑞典 Web 系统增强和发展基于证据的心脏病治疗 (SWEDEHEART) 登记处接受原发性孤立 CABG 的所有患者，在 2014 年 3 月对全因死亡率进行随访。从国家健康数据登记处获得基线特征、全因死亡率和 HF 再入院信息。EF 保留定义为至少 50%。
主要结局是全因死亡率。次要结局指标是全因死亡率和 HF 再入院的组合。
研究纳入了 41906 名患者，其中 37234 名患者无已知 HF（27165 名患者为 pEF，10069 名患者为 rEF），4672 名患者有 HF（1216 名患者为 pEF，3456 名患者为 rEF）。他们的平均（SD）年龄为 67.4（9.3）岁，21.0%为女性。在平均（SD）6.0（3.3）年的随访期间，19.0%（41906 名患者中的 7943 名）的患者死亡，包括无 HF 和 pEF 的患者中 13.2%（27165 名患者中的 3574 名），无 HF 和 rEF 的患者中 24.6%（10069 名患者中的 2476 名），HFpEF 的患者中 33.9%（1216 名患者中的 412 名），HFrEF 的患者中 42.9%（3456 名患者中的 1481 名）。多变量调整后的死亡风险比在无 HF 和 rEF 的患者中为 1.47（95%CI，1.40-1.56），在无 HF 和 rEF 的患者中为 1.62（95%CI，1.46-1.80），在 HFpEF 的患者中为 2.29（95%CI，1.44-2.44）。与无 HF 和 pEF 的患者相比，患者的风险更高。在全因死亡率和 HF 再入院的复合结局中，发现结果相似。手术后 30 天内死亡的多变量调整后的风险比在无 HF 和 rEF 的患者中为 2.25（95%CI，1.86-2.73），在 HFpEF 的患者中为 1.83（95%CI，1.26-2.66），在 HFrEF 的患者中为 2.52（95%CI，1.99-3.19）。
HF 病史是 CABG 后短期和长期预后不良的重要危险因素，与术前 EF 无关。射血分数降低使 CABG 后早期死亡的风险增加一倍以上。
