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The Significance of Heart Failure Symptoms and the Association of Peripheral Vascular Disease and 30-day Mortality in Diabetic Patients With Reduced Ejection Fraction Undergoing Coronary Artery Bypass Grafting
Eugene J. Won1, Rakan Khaki2, Mac Jacobson2, Magarita Camacho1, William Jakobleff1, Tyrone J. Krause1, Ravindra Karanam1, Iosif Gulkarov1, Ioannis Loumiotis1, Matthew Esham2, Fred Sadari1, Arash Salemi1, Louis H. Stein1.
1RWJ/Barnabas Health, Newark, NJ, USA, 2Biome Analytics, San Francisco, CA, USA.

OBJECTIVE: Peripheral vascular disease (PVD) is a known risk factor in coronary artery bypass grafting (CABG) outcomes. The degree of its impact, especially in sicker cohorts, is not well known. We hypothesized that worsening symptoms of heart failure in the setting of PVD may inform a different risk stratification in these patients.
METHODS: We reviewed 46,902 de-identified patients >18 years old within the Biome Database (San Francisco, CA) who underwent cardiac surgery at 56 institutions between 2016-2020. 2,451 patients with a diagnosis of diabetes, LVEF < 30%, and known PVD status who underwent CABG were identified. Correlation of clinical factors including PVD and 30-day mortality was evaluated with logistic regression. Sub-analysis was performed on two groups of patients presenting with either NYHA I-II (n=271) or III-IV (n=2139) symptoms.
RESULTS: Patients with vascular disease had more comorbidities than non-PVD patients including hypertension, elevated creatinine, and a greater number of diseased vessels. Overall, multivariate regression analysis identified PVD, creatinine, shock, and surgery status as predictive of 30-day mortality. For patients with NYHA class I-II symptoms, PVD did not correlate with 30-day outcomes. Among those with NYHA class III-IV symptoms, PVD correlated with 30-day mortality (OR:1.6; p=0.009) on single but not multivariate regression.
CONCLUSIONS: Worsening heart failure symptoms may suggest overall physiologic decompensation. By contributing to vascular ischemia in a low flow state, PVD may worsen these derangements impacting overall outcomes. Preoperative NYHA III-IV symptoms may be an important marker of CABG outcome in diabetic patients with low EF and known vascular disease.


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