The aim – to establish predictors of late major adverse outcomes (MAOs) in patients (pts) with stable coronary artery disease (CAD) after coronary artery bypass grafting (CABG) at three years follow-up.
Material and methods. An observational single-center study included 251 consecutive pts with stable CAD (mean age (61±9) years, 218 (86.9 %) males, 33 (13.1 %) females), after isolated CABG. At three years follow-up, MAOs were registered: death – 11 (4.4 %) cases (among them – 9 cardiovascular death cases); myocardial infarction – 4 (1.6 %); unstable angina – 11 (4.4 %); stroke – 5 (2.0 %); heart failure (HF) decompensation – 20 (8.0 %); sustained ventricular tachycardia – 3 (1.6 %); repeated myocardial revascularization – 10 (4.0 %); peripheral artery embolism – 1 (0.4 %). In total, MAOs occurred in 55 (21.9 %) pts.
Results. At univariate analysis, MAOs were related to the following parameters: age; body mass index; HF IIB stage; permanent AF; estimated glomerular filtration rate (eGFR); left atrium antero-posterior dimension, indexed by body surface area (LAD/BSA); left ventricular (LV) end-diastolic volume index; aortic and mitral valve regurgitation; LV ejection fraction (EF); and early major postoperative complications. At multivariate analysis, the independent predictors of MAOs were following: worse LV systolic function at discharge (by LV EF grades (< 40 % vs 40–49 % vs ≥ 50 %): odds ratio (OR) 2.145 (95 % confidence interval (CI) 1.382–3.329); Р=0,001); worse eGFR at baseline (per each 30 ml/(min · 1.73 m2) decrease vs ≥ 90 ml/(min · 1,73 m2): OR1.951 (95 % CI 1.112–3.421); Р=0.020) and larger LAD/BSA (by degrees of enlargement: OR 1.918 (95 % CI 1.119–3.289); Р=0.018). Conclusions. At three years follow-up, MAOs in pts with stable CAD after CABG were associated with worse baseline filtration kidney function, larger baseline LAD, and worse LV systolic function at discharge. Independent predictive value of baseline eGFR and LAD, and LV EF at discharge should be take into account while planning the postoperative follow-up schedule, as well as individualized prevention of late cardiovascular outcomes.