Six-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use: An Inception Cohort Study
Objective: To inform the design of a pivotal randomized controlled trial of prophylactic intra-aortic balloon counterpulsation (IABC) in patients undergoing coronary artery bypass graft (CABG) at high risk of postoperative low cardiac output syndrome (LCOS). Design: Inception cohort study. Setting:...
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| Format: | Journal Article |
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WB Saunders
2018
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| Online Access: | http://hdl.handle.net/20.500.11937/66883 |
| _version_ | 1848761417439641600 |
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| author | Litton, E. Bass, F. Delaney, A. Hillis, G. Marasco, S. McGuinness, S. Myles, P. Reid, Christopher Smith, J. |
| author_facet | Litton, E. Bass, F. Delaney, A. Hillis, G. Marasco, S. McGuinness, S. Myles, P. Reid, Christopher Smith, J. |
| author_sort | Litton, E. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Objective: To inform the design of a pivotal randomized controlled trial of prophylactic intra-aortic balloon counterpulsation (IABC) in patients undergoing coronary artery bypass graft (CABG) at high risk of postoperative low cardiac output syndrome (LCOS). Design: Inception cohort study. Setting: A total of 13 established cardiac centers in Australia, Canada, New Zealand, and the United Kingdom. Participants: Adult patients were eligible for inclusion if they were listed for CABG surgery and had 2 or more LCOS risk factors (low ejection fraction, severe left main coronary artery disease, redo sternotomy, unstable angina). Interventions: Outcomes of interest were a composite outcome of in-hospital mortality, postoperative acute myocardial infarction (AMI), acute kidney injury (AKI), or stroke as well as 6-month vital status and quality of life using the EuroQol 5-dimensional questionnaire (EQ5D). Measurements and Main Results: The study included 136 participants over a 29-month period. Overall, in-hospital and 6-month mortality occurred in 7 (5%) and 11 (8%) participants, respectively. The composite outcome occurred in 60 (44%). The mean increase in EQ5D summary index at 6 mont hs was 0.10 (standard deviation 0.24, p = 0.01). Perioperative AMI, AKI, or stroke significantly decreased the odds of a clinically meaningful improvement in quality of life (odds ratio 0.32; 95% confidence interval 0.13-0.79; p = 0.014). Preoperative IABC was used in 39 participants and did not predict postoperative outcomes. Conclusions: The study identified a group of patients at risk of LCOS in whom CABG surgery was associated with a substantial burden of perioperative morbidity. Preoperative IABC use was variable, supporting the need for further research. |
| first_indexed | 2025-11-14T10:31:20Z |
| format | Journal Article |
| id | curtin-20.500.11937-66883 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T10:31:20Z |
| publishDate | 2018 |
| publisher | WB Saunders |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-668832018-10-18T03:15:56Z Six-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use: An Inception Cohort Study Litton, E. Bass, F. Delaney, A. Hillis, G. Marasco, S. McGuinness, S. Myles, P. Reid, Christopher Smith, J. Objective: To inform the design of a pivotal randomized controlled trial of prophylactic intra-aortic balloon counterpulsation (IABC) in patients undergoing coronary artery bypass graft (CABG) at high risk of postoperative low cardiac output syndrome (LCOS). Design: Inception cohort study. Setting: A total of 13 established cardiac centers in Australia, Canada, New Zealand, and the United Kingdom. Participants: Adult patients were eligible for inclusion if they were listed for CABG surgery and had 2 or more LCOS risk factors (low ejection fraction, severe left main coronary artery disease, redo sternotomy, unstable angina). Interventions: Outcomes of interest were a composite outcome of in-hospital mortality, postoperative acute myocardial infarction (AMI), acute kidney injury (AKI), or stroke as well as 6-month vital status and quality of life using the EuroQol 5-dimensional questionnaire (EQ5D). Measurements and Main Results: The study included 136 participants over a 29-month period. Overall, in-hospital and 6-month mortality occurred in 7 (5%) and 11 (8%) participants, respectively. The composite outcome occurred in 60 (44%). The mean increase in EQ5D summary index at 6 mont hs was 0.10 (standard deviation 0.24, p = 0.01). Perioperative AMI, AKI, or stroke significantly decreased the odds of a clinically meaningful improvement in quality of life (odds ratio 0.32; 95% confidence interval 0.13-0.79; p = 0.014). Preoperative IABC was used in 39 participants and did not predict postoperative outcomes. Conclusions: The study identified a group of patients at risk of LCOS in whom CABG surgery was associated with a substantial burden of perioperative morbidity. Preoperative IABC use was variable, supporting the need for further research. 2018 Journal Article http://hdl.handle.net/20.500.11937/66883 10.1053/j.jvca.2018.01.005 WB Saunders restricted |
| spellingShingle | Litton, E. Bass, F. Delaney, A. Hillis, G. Marasco, S. McGuinness, S. Myles, P. Reid, Christopher Smith, J. Six-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use: An Inception Cohort Study |
| title | Six-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use: An Inception Cohort Study |
| title_full | Six-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use: An Inception Cohort Study |
| title_fullStr | Six-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use: An Inception Cohort Study |
| title_full_unstemmed | Six-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use: An Inception Cohort Study |
| title_short | Six-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use: An Inception Cohort Study |
| title_sort | six-month outcomes after high-risk coronary artery bypass graft surgery and preoperative intra-aortic balloon counterpulsation use: an inception cohort study |
| url | http://hdl.handle.net/20.500.11937/66883 |