Among Patients with Surgical Coronary Disease who do not Proceed onto Revascularisation, Cardiac Readmission Predicts Long Term Mortality.

Abstract

Background: Medically managed patients with surgical coronary artery disease (CAD) who are not offered revascularisation represent a high-risk cohort. We investigated whether cardiac readmission rates predict a worse prognosis. Method(s): Consecutive medically managed patients with surgical CAD discussed at cardiac conference of a tertiary Australian institution were included between 2012-2021. Surgical CAD was defined as stenosis >70% (or FFR<0.8) in a triple vessel distribution or double vessel distribution with a dominant circumflex and/or significant left main stenosis. Rates of hospital readmission and cardiac complications were recorded at 30-days and 12-months. Long-term mortality data were collected until 31 December 2023. Those with and without 30-day cardiac readmission were compared. Result(s): 121 patients were included after multidisciplinary discussion. Of these, 21 (17.4%) had a 30-day cardiac readmission. Median follow-up was 3.6 years (IQR 1.9-6.4). Those with 30-day readmission were less frequently male [11 (52.4%) vs 74 (74.0%), p=0.049], but were similar in age [70.3 (58.7-82.5) vs 74.5 (68.1-80.5), p=0.15], smoking status [12 (57.1%) vs 60 (60.0%), p=0.81] and diabetic prevalence [13 (61.2%) vs 55 (55.0%), p=0.56]. A significantly higher proportion of patients with a 30-day readmission suffered cardiac death during the follow-up period at both 12-months [7 (33.3%) vs 6 (6.0%), p<0.001, HR 7.83 (2.30-26.71, p=0.001)] and maximal follow-up [11 (52.4%) vs 20 (20.0%), p=0.002, HR 4.40 (1.64-11.80, p=0.003)] (Figure). Conclusion(s): This retrospective cohort study demonstrates patients with medically managed surgical CAD who represent within 30-days are at high-risk of subsequent cardiac mortality. These data suggest we may need to reconsider coronary intervention in high-risk surgical candidates who are initially medically managed but represent early after diagnosis. [Formula presented]Copyright � 2024