Six-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use: An Inception Cohort Study

Edward Litton, the PINBALL study investigators and the ANZICS CTG

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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 months 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.

Original languageEnglish
Pages (from-to)2067-2073
Number of pages7
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume32
Issue number5
DOIs
Publication statusPublished - 1 Oct 2018

Keywords

  • high-risk
  • intra-aortic balloon counterpulsation
  • low cardiac output syndrome
  • prophylaxis

Cite this

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title = "Six-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use: An Inception Cohort Study",
abstract = "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 months 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.",
keywords = "high-risk, intra-aortic balloon counterpulsation, low cardiac output syndrome, prophylaxis",
author = "Edward Litton and Frances Bass and Anthony Delaney and Graham Hillis and Silvana Marasco and Shay McGuinness and Myles, {Paul S.} and Reid, {Christopher M.} and Smith, {Julian A.} and {the PINBALL study investigators and the ANZICS CTG}",
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Six-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use : An Inception Cohort Study. / Litton, Edward; the PINBALL study investigators and the ANZICS CTG.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 32, No. 5, 01.10.2018, p. 2067-2073.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Six-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use

T2 - An Inception Cohort Study

AU - Litton, Edward

AU - Bass, Frances

AU - Delaney, Anthony

AU - Hillis, Graham

AU - Marasco, Silvana

AU - McGuinness, Shay

AU - Myles, Paul S.

AU - Reid, Christopher M.

AU - Smith, Julian A.

AU - the PINBALL study investigators and the ANZICS CTG

PY - 2018/10/1

Y1 - 2018/10/1

N2 - 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 months 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.

AB - 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 months 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.

KW - high-risk

KW - intra-aortic balloon counterpulsation

KW - low cardiac output syndrome

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U2 - 10.1053/j.jvca.2018.01.005

DO - 10.1053/j.jvca.2018.01.005

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