Salil V Deo1, Varun Sundaram2, Brigid Wilson3, Jay Sahadevan4, Sri Krishna Madan Mohan4, Joseph Rubelowsky5, Yakov Elgudin5, Brian Cmolik5. 1. Surgical Services, Louis Stokes Cleveland VA Medical Center, Case School of Medicine, Case Western Reserve University, Cleveland, Ohio; VA Cardiovascular Research Group, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio. Electronic address: svd14@case.edu. 2. VA Cardiovascular Research Group, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio; Division of Cardiovascular Medicine, University Hospitals, Cleveland, Ohio. 3. Research Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio. 4. VA Cardiovascular Research Group, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio; Division of Cardiology, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio. 5. Surgical Services, Louis Stokes Cleveland VA Medical Center, Case School of Medicine, Case Western Reserve University, Cleveland, Ohio.
Abstract
INTRODUCTION: Data regarding 10-year survival and adverse cardiovascular events in patients with metabolic syndrome (MET) after coronary artery bypass grafting (CABG) is limited. METHODS: We compared 10-year events rates for veterans undergoing isolated CABG (January 1, 2005, to December 31, 2014, follow-up October 31, 2019) stratified by presence of metabolic syndrome (MET+) versus without (MET-). A multivariable weighted Cox model was used to analyze all-cause mortality. Competing risk analysis was used to calculate cumulative event rates for congestive heart failure, myocardial infarction, and cerebrovascular events. The Fine-Gray subhazard model was used to determine adjusted association of MET with myocardial infarction and stroke. Congestive heart failure was modeled as a recurrent-event analysis. RESULTS: Nationally, 9615 adults (median age, 60 years; 98.9% men) underwent isolated coronary artery bypass grafting at 41 centers); among them, 3121 out of 9615 (32.5%) had MET. The prevalence of MET increased from (27.88% in 2005 to 34.02% in 2014; P = .02). MET+ group members were likely younger (median age, 63 vs 64 years; P < .01), White (72% vs 68%), and had more peripheral vascular disease (30% vs 28%; P = .04). Multivessel (72% vs 70%; P = .23) and multiarterial (4% vs 4%; P = .14) grafting was performed equally. With a median follow-up of 6.5 years, survival was similar (P = .26); however, MET was associated with higher risks for myocardial infarction (21% vs 16%; hazard ratio, 1.3; P < .01) and recurrent admissions for congestive heart failure. CONCLUSIONS: Patients with metabolic syndrome undergoing coronary artery bypass grafting have higher 10-year cardiovascular event rates. Published by Elsevier Inc.
INTRODUCTION: Data regarding 10-year survival and adverse cardiovascular events in patients with metabolic syndrome (MET) after coronary artery bypass grafting (CABG) is limited. METHODS: We compared 10-year events rates for veterans undergoing isolated CABG (January 1, 2005, to December 31, 2014, follow-up October 31, 2019) stratified by presence of metabolic syndrome (MET+) versus without (MET-). A multivariable weighted Cox model was used to analyze all-cause mortality. Competing risk analysis was used to calculate cumulative event rates for congestive heart failure, myocardial infarction, and cerebrovascular events. The Fine-Gray subhazard model was used to determine adjusted association of MET with myocardial infarction and stroke. Congestive heart failure was modeled as a recurrent-event analysis. RESULTS: Nationally, 9615 adults (median age, 60 years; 98.9% men) underwent isolated coronary artery bypass grafting at 41 centers); among them, 3121 out of 9615 (32.5%) had MET. The prevalence of MET increased from (27.88% in 2005 to 34.02% in 2014; P = .02). MET+ group members were likely younger (median age, 63 vs 64 years; P < .01), White (72% vs 68%), and had more peripheral vascular disease (30% vs 28%; P = .04). Multivessel (72% vs 70%; P = .23) and multiarterial (4% vs 4%; P = .14) grafting was performed equally. With a median follow-up of 6.5 years, survival was similar (P = .26); however, MET was associated with higher risks for myocardial infarction (21% vs 16%; hazard ratio, 1.3; P < .01) and recurrent admissions for congestive heart failure. CONCLUSIONS: Patients with metabolic syndrome undergoing coronary artery bypass grafting have higher 10-year cardiovascular event rates. Published by Elsevier Inc.