Can complexity of coronary lesions and presence of poor targets jeopardize outcome in patients with poor systolic function undergoing coronary artery bypass grafting?

Background

SYNTAX score is an established angiographic scoring system for risk stratification of a patient undergoing coronary revascularization. There was always a theory between cardiac surgeons and interventional cardiologists that a good outcome after coronary artery bypass graft (CABG) operation needs at least one out of two limbs, either good contractility or good targets. If both are jeopardized the outcome will be suboptimal with considerable risky operation. We performed that study to confirm if vessels with poor distal run-off and high complexity of lesions might affect the outcome in those critical cohorts of patients with poor left ventricular function.

Methods

This was a prospective observational non-randomized study. The study included 100 patients with jeopardized left ventricular ejection fraction (EF) <40%. The patients were divided into three groups per SYNTAX score. Group 1: (Score <22), group 2: (Score 22–32) and group 3 (Score >32). 30 days post-operative follow- up was done. The primary end point was the composite criteria of death, myocardial infarction (MI) and stroke.

Results

The mean SYNTAX score of the studied cases was 32.03 ± 9.62. Baseline clinical characteristics were similar among the three groups. The high SYNTAX score group showed more increase in total cardio-pulmonary bypass (CPB) time and cross-clamp time, ICU stay, mechanical ventilation, inotropic support and postoperative blood transfusion than the other two groups. High SYNTAX score showed high positive correlation with the number of grafts. No statistically significant difference was found for major adverse cardiac and cerebrovascular events (MACCE) among the three groups (p-value 0.12).

Conclusions

The complexity of coronary lesions and presence of poor targets were not associated with increased adverse outcomes in patients with low EF undergoing CABG. CABG is still the preferred method of revascularization in patients with complex multi-vessel disease and low EF.