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Eur J Cardiothorac Surg 2007;31:827-833. doi:10.1016/j.ejcts.2006.12.033
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

The impact of diffuseness of coronary artery disease on the outcomes of patients undergoing primary and reoperative coronary artery bypass grafting

^a Maritime Heart Center, Halifax, Nova Scotia, Canada
^b Department of Radiology, Dalhousie University, Halifax, Nova Scotia, Canda

Received 18 September 2006; received in revised form 4 December 2006; accepted 7 December 2006.

^_* Corresponding author. Address: Maritime Heart Center, 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada. Tel.: +1 902 473 3808; fax: +1 902 473 4448. (Email: rogerbaskett{at}hatmail.com).

Objective: Diffuse coronary artery disease jeopardizes myocardium, increasing surgical mortality in primary coronary artery bypass grafting (CABG). We sought to determine the impact of diffuseness on pre- and post-discharge outcomes for both primary and reoperative CABG (REOP). Methods: Using a validated system for measuring diffuseness of coronary disease, preoperative angiograms were scored for primary CABG (n = 792) and REOP cases (n = 268) performed 1997–2004. A diffuseness score (DS) > 18 was defined as elevated. In-hospital mortality, intermediate-term survival, and in-hospital composite outcome (COMP) (one or more of: mortality, stroke, MI, deep sternal infection, sepsis, IABP insertion, or return to OR) were examined. Results: In-hospital mortality and COMP for patients with DS > 18 were significantly higher (7.9% vs 2.4%, p < 0.0001), (17.8% vs 9.2%, p < 0.0001). DS (mean ± SD) was higher in REOP cases than primary CABG (18.9 ± 7.1 vs 14.4 ± 6.0, p < 0.0001). By multivariate analysis, DS > 18 (OR 2.00, 95%CI, 1.20–3.32, p = 0.008) and REOP (OR 2.40, 95%CI, 1.53–3.77, p < 0.0001) were independently associated with COMP. Using propensity scores 82% of cases with DS > 18 (n = 289) were matched 1:1 to cases with DS 18. In-hospital mortality and COMP were significantly higher for cases with DS > 18 (6.9% vs 2.8%, p = 0.02), (16.6% vs 10.4%, p = 0.03). Comparing cases with DS 18 versus DS > 18 and primary CABG versus REOP, survival at 2 years was 92.1% versus 84.5% (p = 0.001) and 92.7% versus 82.7% (p < 0.0001), respectively. Conclusions: Diffuse coronary artery disease is an important predictor of morbidity and mortality in primary and REOP CABG patients, and should be considered in both individual patient assessment and risk adjustment.

Key Words: Coronary angiography • Coronary artery bypass • Diffuseness • Reoperation