Functional Status Indicators and Long-Term Mortality Following Elective Coronary Artery Bypass Grafting: A Multicenter Cohort Study.

BACKGROUND

Coronary artery bypass grafting is the most commonly performed major surgical procedure worldwide. The prognostic value of preoperative functional status measures, including self-perceived health, the physical domain of the MacNew heart-related quality of life score, and estimated maximum oxygen consumption for long-term mortality remains unclear.

METHODS

We included 1146 patients undergoing coronary artery bypass grafting across 7 hospitals in Israel. Three functional status indicators were assessed: self-perceived health, MacNew physical domain score, and estimated maximum oxygen consumption. Associations with all-cause mortality were examined using multivariable Cox regression.

RESULTS

Participants had a mean age of 65.6 ± 10 years, and 260 (23%) were female. Over a median follow-up of 15.4 years (interquartile range, 10), 687 (59.6%) patients died. Multivariable Cox regression identified all functional status indicators to associate with mortality. Impaired self-perceived health was the strongest predictor of mortality (hazard ratio [HR], 1.43 [95% CI, 1.2-1.7], P<0.001), followed by low baseline maximum oxygen consumption (HR, 1.2 [95% CI, 1.0-1.5], P=0.05) and poor MacNew physical domain score (HR, 1.2 [95% CI, 1.0-1.4], P=0.02). Discrimination, according to Harrell's C statistic was highest for self-perceived health (C-index, 0.729 [95% CI, 0.7-0.8], P<0.001). Net reclassification improvement analysis confirmed that self-perceived health provided the greatest incremental value, correctly reclassifying 30% of participants (95% CI, 0.2-0.5; P<0.001) for mortality.

CONCLUSIONS

Self-perceived health demonstrated better prognostic value, exceeding the functional status measures examined. Self-perceived health, a single question indicator, should be considered a key measure for risk stratification and prognosis following coronary artery bypass grafting.

REGISTRATION: URL: https://clinicaltrials.gov; Unique identifier: NCT00356863.