TCT-439 Incidence, Characteristics, and Outcomes of Early Perioperative Graft Failure Following Coronary Artery Bypass Grafting

Abstract

Background: Data on the incidence and outcome of early perioperative graft failure (EPGF) following coronary artery bypass grafting (CABG) are limited. The purpose of this study was to assess the temporal trends of incidence, predictors of EPGF following CABG, and impact of EPGF following CABG on in-hospital morbidity, mortality, length of stay, and cost. Methods: The National Inpatient Sample database was used to identify patients who had EPGF following CABG (January 1, 2003, to December 31, 2016). Univariable and multivariable logistic regressions were used to estimate the odds of in-hospital outcomes between groups. Results: A total of 3,311,984 patients who were admitted for CABG (patients with previous CABG were excluded) were included in the analysis. Of these, 88,712 patients (2.7%) developed EPGF compared with 3,223,272 (97.3%) who did not. During the study period of 14 years, the incidence of EPGF following CABG was 2.7%. There was a decreasing trend of annual rate of EPGF from 2003 to 2016 (Figure 1). Cardiogenic shock (odds ratio [OR]: 1.24; 95% confidence interval [CI]: 1.20-1.28; P < 0.001), prior implantable cardioverter-defibrillator or pacemaker (OR: 1.57; 95% CI: 1.50-1.64; P < 0.001), dyslipidemia (OR: 1.21; 95% CI: 1.19-1.23; P < 0.001), anemia (OR: 1.12; 95% CI: 1.10-1.14; P < 0.001), intra-aortic balloon pump use (OR: 1.50; 95% CI: 1.46-1.54; P < 0.001), Impella use (OR: 1.97; 95% CI: 1.69-2.29; P < 0.001), and need for extracorporeal membrane oxygenation (OR: 1.70; 95% CI: 1.49-1.95; P < 0.001) were strongly associated with EPGF after CABG during the same hospitalization. After propensity score matching, in-hospital mortality was higher among patients with EPGF (4.5% vs 3.1%; P < 0.001). EPGF following CABG was associated with increase in length of stay (9 [6-13] vs 8 [6-11]) days, and a >10% increase in cost. [Formula presented] Conclusion: EPGF after CABG has serious clinical implications and is associated with a higher rate of complications, a higher rate of hospital mortality, greater cost, and increased length of stay. Categories: CORONARY: Cardiac and Coronary Artery Surgery and Hybrid Revascularization