Abstract
Ethnicity is not incorporated into standardized pre-operative risk-stratification tools for cardiac surgery. This study compared short-term outcomes following coronary artery bypass graft (CABG) surgery in South Asian and non-Asian patients. Consecutive patients undergoing isolated CABG surgery via sternotomy between the years 2011 and 2019 were retrospectively analyzed. Initially, 1957 patients were identified (799 South-Asian, 40.8%). The patient groups were then propensity matched according to 10 relevant pre-operative covariates (age, body mass index, pulmonary disease, renal failure, smoking, diabetes, ventricular function, renal failure): 675 non-Asian patients were matched against 675 Asian patients. Operative mortality was 1.77% and similar between the two groups (p = 0.447). Multivariate regression analysis found predictors of operative mortality to be pre-operative serum creatinine, age, left ventricular (LV) impairment, and extent of coronary disease. The effect of creatinine on mortality was selective for South-Asian patients (p = 0.015). LV impairment was a predictor of mortality in non-Asian patients, however this effect did not exist in South-Asian patients. Predictors of short-term complications (composite of death, stroke, reoperation, hemofiltration, and pneumonia) were age and creatinine (coefficient 0.002, 95% CI 0.0004-0.004, p = 0.019) in the overall cohort. Subgroup analysis found age to remain a selective negative predictor of complications in South-Asian patients. Cox regression analysis found creatinine, age, and LVEF to influence 10-year survival, whilst ethnicity was not a predictor. This study highlights the cumulative risk associated with ethnicity and renal disease in predicting short-term outcomes following CABG. This warrants further investigations in larger populations, thus guiding pre-operative risk-stratification.
Highlights
Coronary artery bypass graft (CABG) surgery is an extremely common method of myocardial revascularization.[1]
The aim of this study is to explore the outcomes in a large cohort of patients undergoing coronary artery bypass graft (CABG) surgery, comparing groups of South-Asian and Non-Asian patients using propensity matched analysis
The patient groups were propensity matched according to 10 relevant preoperative covariates (Age, gender, BMI, COPD, renal failure, smoking, diabetes, LVEF, peripheral vascular disease, operating surgeon): 675 non-Asian patients were matched against 675 South-Asian patients
Summary
Coronary artery bypass graft (CABG) surgery is an extremely common method of myocardial revascularization.[1]. This study compared short-term outcomes following coronary artery bypass graft (CABG) surgery in South Asian and non-Asian patients. Multivariate regression analysis found predictors of operative mortality to be pre-operative serum creatinine, age, left ventricular (LV) impairment, and extent of coronary disease. The effect of creatinine on mortality was selective for South-Asian patients (p = 0.015). Subgroup analysis found age to remain a selective negative predictor of complications in South-Asian patients. Conclusion: This study highlights the cumulative risk associated with ethnicity and renal disease in predicting short-term outcomes following CABG. This warrants further investigations in larger populations, guiding pre-operative riskstratification
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