Impact of Intubation Time on Survival following Coronary Artery Bypass Grafting

Insights from the Surgical Treatment for Ischemic Heart Failure (STICH) Trial

Nadia Bouabdallaoui, Susanna R. Stevens, Torsten Doenst, Krzysztof Wrobel, Denis Bouchard, Marek A. Deja, Robert E. Michler, Yeow Leng Chua, Renato A.K. Kalil, Craig H. Selzman, Richard C. Daly, Benjamin Sun, Ljubomir T. Djokovic, George Sopko, Eric J. Velazquez, Jean L. Rouleau, Kerry L. Lee, Hussein R. Al-Khalidi

Research output: Contribution to journalArticle

Abstract

Objective: The authors aimed to assess determinants of intubation time and evaluate its impact on 30-day and 1-year postoperative survival in Surgical Treatment for Ischemic Heart Failure (STICH) trial patients. Design, Setting, Participants, and Interventions: A multivariable Cox proportional hazards model was used among the 1,446 surgical patients from the STICH trial who survived 36 hours after operation, in order to identify perioperative factors associated with 30-day and 1-year postoperative mortality. A multivariable logistic regression model was used to determine risk factors associated with intubation time. Measurements and Main Results: At 36 hours post-operation, 1,298 (out of 1,446) were extubated and 148 (10.2%) still intubated. Median postoperative intubation time was 11.4 hours. Among patients surviving 36 hours, a multivariable model was developed to predict 30-day (c-index = 0.88) and 1-year (c-index = 0.78) mortality. Intubation time was the strongest independent predictor of 30-day (hazard ratio [HR] 5.50) and 1-year mortality (HR 3.69). Predictors of intubation time >36 hours included mitral valve procedure, New York Heart Association class, left ventricular systolic volume index, creatinine, previous coronary artery bypass grafting (CABG), and age. Results were similar in patients surviving 24 hours post-operation, where intubation time was also the strongest predictor of 30-day (HR 4.18, c-index 0.87) and 1-year (HR 2.81, c-index 0.78) mortality. Conclusions: Intubation time is the strongest predictor of 30-day and 1-year mortality among patients with ischemic heart failure undergoing CABG. Combining intubation time with other mortality risk factors may allow the identification of patients at the highest risk for whom the development of specific strategies may improve outcomes.

Original languageEnglish (US)
JournalJournal of Cardiothoracic and Vascular Anesthesia
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Intubation
Coronary Artery Bypass
Heart Failure
Survival
Mortality
Therapeutics
Logistic Models
Mitral Valve
Proportional Hazards Models
Creatinine

Keywords

  • Coronary artery bypass grafting
  • Coronary artery disease
  • Heart failure
  • Intubation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Impact of Intubation Time on Survival following Coronary Artery Bypass Grafting : Insights from the Surgical Treatment for Ischemic Heart Failure (STICH) Trial. / Bouabdallaoui, Nadia; Stevens, Susanna R.; Doenst, Torsten; Wrobel, Krzysztof; Bouchard, Denis; Deja, Marek A.; Michler, Robert E.; Chua, Yeow Leng; Kalil, Renato A.K.; Selzman, Craig H.; Daly, Richard C.; Sun, Benjamin; Djokovic, Ljubomir T.; Sopko, George; Velazquez, Eric J.; Rouleau, Jean L.; Lee, Kerry L.; Al-Khalidi, Hussein R.

In: Journal of Cardiothoracic and Vascular Anesthesia, 01.01.2018.

Research output: Contribution to journalArticle

Bouabdallaoui, N, Stevens, SR, Doenst, T, Wrobel, K, Bouchard, D, Deja, MA, Michler, RE, Chua, YL, Kalil, RAK, Selzman, CH, Daly, RC, Sun, B, Djokovic, LT, Sopko, G, Velazquez, EJ, Rouleau, JL, Lee, KL & Al-Khalidi, HR 2018, 'Impact of Intubation Time on Survival following Coronary Artery Bypass Grafting: Insights from the Surgical Treatment for Ischemic Heart Failure (STICH) Trial', Journal of Cardiothoracic and Vascular Anesthesia. https://doi.org/10.1053/j.jvca.2017.12.038
Bouabdallaoui, Nadia ; Stevens, Susanna R. ; Doenst, Torsten ; Wrobel, Krzysztof ; Bouchard, Denis ; Deja, Marek A. ; Michler, Robert E. ; Chua, Yeow Leng ; Kalil, Renato A.K. ; Selzman, Craig H. ; Daly, Richard C. ; Sun, Benjamin ; Djokovic, Ljubomir T. ; Sopko, George ; Velazquez, Eric J. ; Rouleau, Jean L. ; Lee, Kerry L. ; Al-Khalidi, Hussein R. / Impact of Intubation Time on Survival following Coronary Artery Bypass Grafting : Insights from the Surgical Treatment for Ischemic Heart Failure (STICH) Trial. In: Journal of Cardiothoracic and Vascular Anesthesia. 2018.
@article{db65159c7c714e7d99a1d8eaea38ce76,
title = "Impact of Intubation Time on Survival following Coronary Artery Bypass Grafting: Insights from the Surgical Treatment for Ischemic Heart Failure (STICH) Trial",
abstract = "Objective: The authors aimed to assess determinants of intubation time and evaluate its impact on 30-day and 1-year postoperative survival in Surgical Treatment for Ischemic Heart Failure (STICH) trial patients. Design, Setting, Participants, and Interventions: A multivariable Cox proportional hazards model was used among the 1,446 surgical patients from the STICH trial who survived 36 hours after operation, in order to identify perioperative factors associated with 30-day and 1-year postoperative mortality. A multivariable logistic regression model was used to determine risk factors associated with intubation time. Measurements and Main Results: At 36 hours post-operation, 1,298 (out of 1,446) were extubated and 148 (10.2{\%}) still intubated. Median postoperative intubation time was 11.4 hours. Among patients surviving 36 hours, a multivariable model was developed to predict 30-day (c-index = 0.88) and 1-year (c-index = 0.78) mortality. Intubation time was the strongest independent predictor of 30-day (hazard ratio [HR] 5.50) and 1-year mortality (HR 3.69). Predictors of intubation time >36 hours included mitral valve procedure, New York Heart Association class, left ventricular systolic volume index, creatinine, previous coronary artery bypass grafting (CABG), and age. Results were similar in patients surviving 24 hours post-operation, where intubation time was also the strongest predictor of 30-day (HR 4.18, c-index 0.87) and 1-year (HR 2.81, c-index 0.78) mortality. Conclusions: Intubation time is the strongest predictor of 30-day and 1-year mortality among patients with ischemic heart failure undergoing CABG. Combining intubation time with other mortality risk factors may allow the identification of patients at the highest risk for whom the development of specific strategies may improve outcomes.",
keywords = "Coronary artery bypass grafting, Coronary artery disease, Heart failure, Intubation",
author = "Nadia Bouabdallaoui and Stevens, {Susanna R.} and Torsten Doenst and Krzysztof Wrobel and Denis Bouchard and Deja, {Marek A.} and Michler, {Robert E.} and Chua, {Yeow Leng} and Kalil, {Renato A.K.} and Selzman, {Craig H.} and Daly, {Richard C.} and Benjamin Sun and Djokovic, {Ljubomir T.} and George Sopko and Velazquez, {Eric J.} and Rouleau, {Jean L.} and Lee, {Kerry L.} and Al-Khalidi, {Hussein R.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1053/j.jvca.2017.12.038",
language = "English (US)",
journal = "Journal of Cardiothoracic and Vascular Anesthesia",
issn = "1053-0770",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Impact of Intubation Time on Survival following Coronary Artery Bypass Grafting

T2 - Insights from the Surgical Treatment for Ischemic Heart Failure (STICH) Trial

AU - Bouabdallaoui, Nadia

AU - Stevens, Susanna R.

AU - Doenst, Torsten

AU - Wrobel, Krzysztof

AU - Bouchard, Denis

AU - Deja, Marek A.

AU - Michler, Robert E.

AU - Chua, Yeow Leng

AU - Kalil, Renato A.K.

AU - Selzman, Craig H.

AU - Daly, Richard C.

AU - Sun, Benjamin

AU - Djokovic, Ljubomir T.

AU - Sopko, George

AU - Velazquez, Eric J.

AU - Rouleau, Jean L.

AU - Lee, Kerry L.

AU - Al-Khalidi, Hussein R.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: The authors aimed to assess determinants of intubation time and evaluate its impact on 30-day and 1-year postoperative survival in Surgical Treatment for Ischemic Heart Failure (STICH) trial patients. Design, Setting, Participants, and Interventions: A multivariable Cox proportional hazards model was used among the 1,446 surgical patients from the STICH trial who survived 36 hours after operation, in order to identify perioperative factors associated with 30-day and 1-year postoperative mortality. A multivariable logistic regression model was used to determine risk factors associated with intubation time. Measurements and Main Results: At 36 hours post-operation, 1,298 (out of 1,446) were extubated and 148 (10.2%) still intubated. Median postoperative intubation time was 11.4 hours. Among patients surviving 36 hours, a multivariable model was developed to predict 30-day (c-index = 0.88) and 1-year (c-index = 0.78) mortality. Intubation time was the strongest independent predictor of 30-day (hazard ratio [HR] 5.50) and 1-year mortality (HR 3.69). Predictors of intubation time >36 hours included mitral valve procedure, New York Heart Association class, left ventricular systolic volume index, creatinine, previous coronary artery bypass grafting (CABG), and age. Results were similar in patients surviving 24 hours post-operation, where intubation time was also the strongest predictor of 30-day (HR 4.18, c-index 0.87) and 1-year (HR 2.81, c-index 0.78) mortality. Conclusions: Intubation time is the strongest predictor of 30-day and 1-year mortality among patients with ischemic heart failure undergoing CABG. Combining intubation time with other mortality risk factors may allow the identification of patients at the highest risk for whom the development of specific strategies may improve outcomes.

AB - Objective: The authors aimed to assess determinants of intubation time and evaluate its impact on 30-day and 1-year postoperative survival in Surgical Treatment for Ischemic Heart Failure (STICH) trial patients. Design, Setting, Participants, and Interventions: A multivariable Cox proportional hazards model was used among the 1,446 surgical patients from the STICH trial who survived 36 hours after operation, in order to identify perioperative factors associated with 30-day and 1-year postoperative mortality. A multivariable logistic regression model was used to determine risk factors associated with intubation time. Measurements and Main Results: At 36 hours post-operation, 1,298 (out of 1,446) were extubated and 148 (10.2%) still intubated. Median postoperative intubation time was 11.4 hours. Among patients surviving 36 hours, a multivariable model was developed to predict 30-day (c-index = 0.88) and 1-year (c-index = 0.78) mortality. Intubation time was the strongest independent predictor of 30-day (hazard ratio [HR] 5.50) and 1-year mortality (HR 3.69). Predictors of intubation time >36 hours included mitral valve procedure, New York Heart Association class, left ventricular systolic volume index, creatinine, previous coronary artery bypass grafting (CABG), and age. Results were similar in patients surviving 24 hours post-operation, where intubation time was also the strongest predictor of 30-day (HR 4.18, c-index 0.87) and 1-year (HR 2.81, c-index 0.78) mortality. Conclusions: Intubation time is the strongest predictor of 30-day and 1-year mortality among patients with ischemic heart failure undergoing CABG. Combining intubation time with other mortality risk factors may allow the identification of patients at the highest risk for whom the development of specific strategies may improve outcomes.

KW - Coronary artery bypass grafting

KW - Coronary artery disease

KW - Heart failure

KW - Intubation

UR - http://www.scopus.com/inward/record.url?scp=85041585826&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041585826&partnerID=8YFLogxK

U2 - 10.1053/j.jvca.2017.12.038

DO - 10.1053/j.jvca.2017.12.038

M3 - Article

JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

SN - 1053-0770

ER -