Identifying coronary artery bypass grafting patients at high risk for adverse long-term prognosis using serial health-related quality of life assessments

Background:Patients who undergo coronary artery bypass grafting(CABG)are known to be at a significant risk of experiencing long-term adverse events,emphasizing the importance of regular assessments.Evaluating health-related quality of life(HRQoL)serves as a direct method to gauge prognosis.Our objective is to ascertain the prognostic significance of consecutive HRQoL assessments using the Physical Component Summary(PCS)and Mental Component Summary(MCS)derived from the Short-Form 36(SF-36)health survey in CABG patients.Methods:The study population consisted of 433 patients who underwent isolated elective CABG at Fuwai Hospital between 2012 and 2013.SF-36 assessments were conducted during both the hospitalization period and follow-up.The primary endpoint of the study was all-cause mortality,while the secondary outcome was a composite measure including death,myocardial infarction,stroke,and repeat revascularization.We assessed the relationships between the PCS and MCS at baseline,as well as their changes during the first 6 months after the surgery(referred to asΔPCS andΔMCS,respectively),and the observed outcomes.Results:The patients were followed for an average of 6.28 years,during which 35 individuals(35/433,8.1%)died.After adjusting for clinical variables,it was observed that baseline MCS scores(hazard ratio[HR]for a 1-standard deviation[SD]decrease,1.57;95%confidence interval[CI],1.07-2.30)andΔMCS(HR for a 1-SD decrease,1.67;95%CI,1.09-2.56)were associated with all-cause mortality.However,baseline PCS scores andΔPCS did not exhibit a significant relationship with all-cause mortality.Notably,there was a dose-response relationship observed betweenΔMCS and the likelihood of all-cause mortality(HRs for the 2nd,3rd and 4th quartiles compared to the 1st quartile,0.33,0.45 and 0.11,respectively).Conclusions:Baseline MCS and changes in MCS were independent predictors for long-term mortality of CABG.Better mental health status and recovery indicated better prognosis.