Prior coronary Artery bypass Surgery and risk of death among patients with ischemic Left Ventricular Dysfunction

• Published in: Circulation (New York, N.Y.) N.Y.), 2001-09, Vol.104 (13), p.1489-1493
• Main Authors: VEENHUYZEN, George D, SINGH, Steven N, MCAREAVEY, Dorothea, SHELTON, Brent J, EXNER, Derek V
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Coronary Artery Bypass; Death, Sudden, Cardiac - etiology; Female; Humans; Male; Medical sciences; Middle Aged; Myocardial Ischemia - complications; Myocardial Ischemia - mortality; Preoperative Care; Risk Assessment - statistics & numerical data; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Ventricular Dysfunction, Left - complications; Ventricular Dysfunction, Left - mortality
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/hc3801.096335

Patients with ischemic LV dysfunction are at high risk of sudden death. However, no benefit from prophylactic defibrillator therapy was observed in a group of patients with LV dysfunction undergoing CABG (CABG Patch trial). Thus, the effect of CABG on future risk of sudden death in patients with LV dysfunction is of considerable interest. Mortality and modes of death in 5410 patients with ischemic LV dysfunction who were enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) trials were evaluated. Outcomes of patients with (n=1870, 35%) versus without (n=3540) history of prior CABG were compared, and stratification by baseline ejection fraction (EF) values (0.30) was performed. Prior CABG was associated with a 25% (95% CI, 15% to 36%) reduction in risk of death and a 46% (95% CI, 30% to 58%) reduction in risk of sudden death independent of EF and severity of heart failure symptoms. As baseline EF declined, absolute reduction in risk of sudden death with prior CABG increased (P