CARDIORESPIRATORY FITNESS AND SHORT TERM OUTCOMES WITH CORONARY ARTERY BYPASS GRAFT SURGERY

E1946 JACC March 27, 2012 Volume 59, Issue 13

Diagnostic Testing: ECG Exercise and Sports CARDIORESPIRATORY FITNESS AND SHORT TERM OUTCOMES WITH CORONARY ARTERY BYPASS GRAFT SURGERY ACC Oral Contributions McCormick Place South, S503 Sunday, March 25, 2012, 11:45 a.m.-Noon

Session Title: Diagnostic Testing; ECG and Cardiopulmonary Exercise Testing Abstract Category: 25. Diagnostic Testing: ECG Exercise Presentation Number: 929-7 Authors: James L. Smith, Thomas A. Verrill, Judy A. Boura, Marc P. Sakwa, Francis L. Shannon, Barry Franklin, William Beaumont Hospital, Royal Oak, MI, USA Background: Pre-operative risk assessment for coronary artery bypass surgery (CABG) has been evaluated with multiple predictive models; yet none incorporate low cardiorespiratory fitness as a risk factor. The present study evaluates pre-operative metabolic equivalents (METs) and short term morbidity and mortality after CABG. Methods: The Society of Thoracic Surgeons database was queried for patients undergoing CABG from January 2002 to December 2010 at Beaumont Health Systems. The electronic medical record was reviewed for peak or symptom-limited stress testing < 90 days prior to surgery. METs were estimated from the achieved treadmill speed, grade, and duration, or the cycle ergometer workload corrected for body weight. Results: 596 patients were categorized into 2 groups: those with low aerobic capacity (<5 METs); and those achieving ≥ 5 METs. Fisher’s exact tests compared pre-operative aerobic capacity and post-operative morbidity and mortality between the two groups (Table 1). After adjusting for potential confounding variables, we found an inverse relationship between cardiorespiratory fitness and complications after CABG. Comment: Low pre-operative cardiorespiratory fitness was associated with higher operative mortality, 30 day mortality, sternal wound infections, and prolonged ventilation after CABG. These data suggest that pre-operative cardiorespiratory fitness provides an independent and additive marker of prognosis after CABG that has not been previously reported.

TABLE 1

METS <5 N=78

METS ≥5 N=518

P value

Sternal Wound Infections

2 (2.6%)

0

0.017

Neuro-Permanent Stroke

2 (2.6%)

8 (1.5%)

0.63

Prolonged Ventilation

10 (12.8%)

34 (6.6%)

0.049

Atrial or ventricular arrhythmia

0

15 (2.9%)

0.24

Re-operation Due to Bleeding or Tamponade

3 (3.9%)

8 (1.5%)

0.16

Mortality Operative

4 (5.1%)

5 (1.0%)

0.021

Mortality- 30 day

4 (5.1%)

6 (1.2%)

0.031