PURPOSE: Several studies have shown chronic obstructive pulmonary disease (COPD) to be a risk factor for post-coronary artery bypass grafting (CABG) complications. However, there is little data on patients with restrictive lung disease undergoing CABG. We retrospectively studied outcomes in patients who had patterns consistent with restrictive lung disease on preoperative pulmonary function testing (PFT).
METHODS: Patients (n=379) who underwent CABG between January 2008 and June 2009 were included. PFT, in-hospital mortality, postoperative myocardial infarction (MI) and atrial fibrillation, and length of hospital stay (LOS) were recorded. Spirometric abnormalities were classified into restrictive and obstructive patterns. Data was analyzed using SPSS 16 using appropriate statistical tests for comparing outcomes between groups.
RESULTS: PFT data was available in 120 patients among whom only 36 were previously diagnosed with chronic obstructive lung disease. There was no statistical difference in the baseline clinical characteristics of these groups. (age, sex, BMI, number of grafts, preoperative beta blocker, statin and ACEI use). Patients with restrictive lung pattern (n=31) when compared to those with obstructive (n=22) or normal patterns (n=63), were more likely to die during hospitalization (9.7% vs. 0% vs. 0%, p < 0.05), suffer perioperative MI (3% vs. 0% vs. 0%, p>0.05) and have a longer average LOS (12.2 days vs. 9.8 days vs. 9.6 days, p>0.05).The rate of post operative atrial fibrillation in these three groups was statistically nonsignificant (41% vs. 22.2% vs. 43.1%).
CONCLUSION: Restrictive pattern on spirometry is associated with a statistically significant increase in mortality post CABG. There is a trend towards increased incidence of postoperative MI and longer hospital LOS. Further studies are needed to confirm this observation.
CLINICAL IMPLICATIONS: Patients with restrictive lung disease may have a higher risk of post-CABG mortality.
DISCLOSURE: Jonaid Aslam, No Financial Disclosure Information; No Product/Research Disclosure Information