Abstract
Background: With an ageing and increasingly multi-morbid population, the use of coronary artery bypass grafting (CABG) is expected to increase. As short-term CABG mortality rates have decreased, estimating long-term outcomes for patients with specific risk factors has become more relevant. Previous single observational studies have identified risk factors for adverse long-term outcomes, such as older age and diabetes. Purpose: Understanding the pre-operative characteristics that affect late mortality post-CABG can lead to effective risk stratification and enhancement of secondary prevention programmes, thereby aiming to improve long-term prognosis after the procedure. Methods: MEDLINE, Embase, Google Scholar, and Cochrane electronic databases were searched to identify all relevant articles evaluating associations between pre-operative risk factors and long-term mortality (≥5 years ) post-CABG. Studies with <500 patients were excluded. Results: From 1193 potentially eligible articles, 43 studies met the inclusion criteria. A total of 360,481 patients, with an average follow-up of 10 years, were included, representing an approximate cumulative total of 3,604,810 person-years. After pooling adjusted hazard ratios, 6 major risk factors were found to be independently associated with long-term mortality after CABG: age, ischaemia (peripheral vascular disease, prior cerebrovascular accident, left main stem coronary disease), diabetes mellitus, atrial fibrillation, renal impairment (chronic kidney disease and dialysis-dependent chronic kidney disease), and impaired left ventricular function (reduced LV ejection fraction or prior heart failure) (see Table 1). Conclusion: We have identified six groups of risk factors for long-term mortality post-CABG. Further work is needed to assess whether the influence of these risk factors varies over time and if targeted interventions for high-risk groups lead to improved long-term mortality.
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