Deterioration of Regional Wall Motion Immediately after Coronary Artery Bypass Graft Surgery Is Associated with Long-term Major Adverse Cardiac Events

Abstract

Patients undergoing coronary artery bypass graft (CABG) surgery frequently develop wall motion abnormalities diagnosed by intraoperative transesophageal echocardiography. However, the relation between deterioration in wall motion and postoperative morbidity or mortality is unclear. Therefore, the authors hypothesized that deterioration in intraoperative left ventricular regional wall motion immediately after CABG surgery is associated with a higher risk of adverse cardiac events. With institutional review board approval, data were gathered from 1,412 CABG surgery patients. Echocardiographic wall motion score (WMS) was derived using a 16-segment model. Outcomes data were gathered for up to 2 yr after surgery. The primary outcome, major adverse cardiac event, was a composite index of myocardial infarction, need for subsequent coronary revascularization, or all-cause mortality during the follow-up period. Two hundred twenty-one patients (16%) had 254 primary outcome events during follow-up. Postbypass WMS did not change in 812 patients (58%), deteriorated in 219 patients (16%), and improved in 368 patients (26%). Kaplan-Meier analysis showed that patients with deterioration in WMS after CABG experienced significantly lower major adverse cardiac event-free survival than patients with either no change or improvement in WMS (P = 0.004). Cox proportional hazards regression modeling revealed a significant association between deterioration in WMS and the composite adverse outcome (hazard ratio, 1.47 [1.06-2.03]; P = 0.02). The authors confirmed their hypothesis that deterioration in wall motion detected by intraoperative echocardiography after CABG surgery is associated with increased risk of long-term adverse cardiac morbidity. Worsening wall motion after CABG surgery should be considered a prognostic indicator of adverse cardiovascular outcome.