Cited by 286Cardiac and Coronary Surgery TechniquesMechanical Circulatory Support DevicesCardiac, Anesthesia and Surgical Outcomes

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Predictors of low cardiac output syndrome after coronary artery bypass

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Rao, Vivek, Ivanov, Joan, Weisel, Richard D., Ikonomidis, John S., Christakis, George T., David, Tirone E.·1996·The Journal of Thoracic and Cardiovascular Surgery

DOI 10.1016/s0022-5223(96)70176-9

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Abstract

The purpose of this study was to identify patients at risk for the development of low cardiac output syndrome after coronary artery bypass. Low cardiac output syndrome was defined as the need for postoperative intraaortic balloon pump or inotropic support for longer than 30 minutes in the intensive care unit to maintain the systolic blood pressure greater than 90 mm Hg and the cardiac index greater than 2.2 L/min per square meter. The preoperative patient characteristics that were independent predictors of low cardiac output syndrome were identified among 4558 consecutive patients who underwent isolated coronary artery bypass at The Toronto Hospital between July 1, 1990, and December 31, 1993. The overall prevalence of low cardiac output syndrome was 9.1% (n = 412). The operative mortality rate was higher in patients in whom low cardiac output syndrome developed than in those in whom it did not develop (16.9% versus 0.9%, p < 0.001). Stepwise logistic regression analyses identified nine independent predictors of low output syndrome (percent frequency in parentheses) and calculated the factor-adjusted odds ratios associated with each predictor: (1) left ventricular ejection fraction less than 20% (27%, odds ratio 5.7); (2) repeat operation (25%, odds ratio 4.4); (3) emergency operation (27%, odds ratio 3.7); (4) female gender (16%, odds ratio 2.5); (5) diabetes (13%, odds ratio 1.6); (6) age older than 70 years (13%, odds ratio 1.5); (7) left main coronary artery stenosis (12%, odds ratio 1.4); (8) recent myocardial infarction (16%, odds ratio 1.4); and (9) triple-vessel disease (10%, odds ratio 1.3). Low cardiac output syndrome is a clinical outcome that may result from inadequate myocardial protection or perioperative ischemic injury. Patients at high risk for the development of low cardiac output syndrome should be the focus of trials of new techniques of myocardial protection to resuscitate the ischemic myocardium.

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Background
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Seadler, B. D., Melamed, J., Sow, M., Rogers, A. L., Syed, A., Linsky, P. L., Ubert, H. A., Schena, S., Durham, L. A., & Almassi, G. H. (2024) · Artificial Organs · doi:10.1111/aor.14722
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Valoración integral tras cirugía cardiaca de pacientes con síndrome de bajo gasto cardiaco posoperatorio
Ayán, M. P. S., Vela, J. L. P., Domínguez-Aguado, H., Linares, Á. M., & Esteve, A. E. (2025) · Rehabilitación · doi:10.1016/j.rh.2025.100953
Additional file 1 of The impact of glutamate infusion on postoperative NT-proBNP in patients undergoing coronary artery bypass surgery: a randomized study
JIANG, H., Holm, J., Vidlund, M., Vánky, F. B., Friberg, Ö., Yang, Y., & Svedjeholm, R. (2020) · Figshare · doi:10.6084/m9.figshare.12285527
Additional file 1 of Improved early risk stratification of deep sternal wound infection risk after coronary artery bypass grafting
Kamenšek, T., Kalisnik, J. M., Ledwon, M., Santarpino, G., Fittkau, M., Vogt, F. A., & Žibert, J. (2024) · Figshare · doi:10.6084/m9.figshare.25223436
The Use of Intra-Aortic Balloon Pumping in Cardiac Surgery
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Theoretical-Causal Validation of Risk Factors for the Nursing Diagnosis of Decreased Cardiac Output: A Systematic Review of the Literature with Meta-Analysis
Júnior, J. A. D. ́., da Silva, A. B., Lopes, M. V. D. O., dos Santos, Í. K., de Almeida, D. R. Q., Andrade, C. D. M., Fernandes, T. A. A. D. M., & do Nascimento, E. G. C. (2026) · International Journal of Nursing Knowledge · doi:10.1177/20473087261460960
“…p < 0.001; p = 0.007, respectively) and female sex ) Kochar et al., 2022; Duncan et al., 2022; Christakis et al., 1995; Huang et al., 2022; Rao et al., 1996; Yau et al., 1999; Woods et al., 2003; Solomon et al., 2004; Algarni et al., 2011; Avila-Vanzzini et al., 2020; 2) Kochar et al.,…”
Influential
Coronary sinus lactate at reperfusion: A predictor of atrial fibrillation after coronary artery bypass grafting
Verma, A., Shin, B., Hirji, S. A., Gilfeather, M. S., Danesi, T. H., Sabe, A. A., Sundt, T. M., & Aranki, S. F. (2026) · JTCVS Open · doi:10.1016/j.xjon.2026.101971
“Finally, telemetry surveillance was discontinued at the time of hospital discharge; consequently, late-onset AF occurring after discharge is not captured, and the true incidence of POAF in this cohort may be underestimated.”
Anesthésie-réanimation en chirurgie cardiaque
Denault, A. Y., Ased, H., & Lebon, J.-S. (2014) · Arnette eBooks · doi:10.3917/arne.fella.2014.01.0239
Mental Health Factors in Cardiothoracic Surgery Risk Prediction Models: A Systematic Review
Rios-Monterrosa, J. L., Artunduaga, M. C., Rasheed, N., Aguiar, C., Castro, S. J., Jaime, M., Lang, E., Woodward, A. L., & Sun, L. Y. (2026) · Journal of the American Heart Association · doi:10.1161/jaha.126.052512
BindingDB Entry 50018429: Nitrile-containing pharmaceuticals: target, mechanism of action, and their SAR studies.
BindingDB (2024) · UC San Diego · doi:10.7270/q29z993j

Authors: Rao, V., Ivanov, J., Weisel, R. D., Ikonomidis, J. S., Christakis, G. T., & David, T. E.
Affiliations: University of Toronto (CA)
ORCID: Rao, Vivek
Ikonomidis, John S.
David, Tirone E.
Venue: The Journal of Thoracic and Cardiovascular Surgery
Publisher: Elsevier BV
Published: 1996-07
Volume: 112
Issue: 1
Pages: 38-51
ISSN: 0022-5223 (ISSN-L)
DOI: 10.1016/s0022-5223(96)70176-9
OpenAlex: W2072841444
Cited by: 286
References: 32
Citations by year: 2026: 4 · 2025: 7 · 2024: 6 · 2023: 14 · 2022: 6 · 2021: 9 · 2020: 15 · 2019: 7 · 2018: 11 · 2017: 9 · 2016: 10 · 2015: 7 · 2014: 12 · 2013: 9 · 2012: 17
FWCI: 5.41
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 7310 d)
Locations: Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
PubMed (publishedVersion)
Funders: Heart and Stroke Foundation of Canada
Medical Research Council Canada
Medical Research Council
Topics: Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Mechanical Circulatory Support Devices
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
Keywords: low cardiac output syndrome, coronary artery bypass grafting, risk factors, left ventricular ejection fraction, reoperation, emergency surgery, female sex, diabetes mellitus, old age, left main coronary artery stenosis, recent myocardial infarction, three-vessel coronary artery disease, postoperative mortality, cardioprotection, perioperative myocardial ischemia, intra-aortic balloon pump, inotropic support
MeSH terms: Aged, Coronary Artery Bypass, Cardiac Output, Low, Female, Humans, Male, Middle Aged, Postoperative Complications, Prognosis, Prospective Studies, Sex Factors, Syndrome, Survival Rate, Odds Ratio, Ventricular Dysfunction, Left, Diabetes Complications

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Predictors of low cardiac output syndrome after coronary artery bypass

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