Pre-operative intra-aortic balloon pump insertion in coronary artery bypass grafting patients reduces in-hospital morbidity 

Pre-operative intra-aortic balloon pump insertion in coronary artery bypass grafting patients reduces in-hospital morbidity | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Pre-operative intra-aortic balloon pump insertion in coronary artery bypass grafting patients reduces in-hospital morbidity Faizus Sazzad, Hai Dong Luo, Guohao Chang, Duoduo Wu, Zhi Xian Ong, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3960669/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 23 You are reading this latest preprint version Abstract Background: The aim of this study was to determine if pre-operative intra-aortic balloon pump (IABP) insertion improves the surgical outcomes of coronary artery bypass grafting (CABG). Methods: Patients with EuroSCORE II > 1.2% who underwent CABG from 2009 to 2016 were included in the study. Patients who utilized intra-operative or post-operative IABP were excluded. The analysis included a total of 2907 patients, with 377 patients undergoing pre-operative IABP insertion and 1198 patients receiving no IABP support. Following propensity score matching, 250 patients from each group were eligible for further analysis. Results: 30-day mortality events occurred in 9 (3.6%) non-IABP users and in 12 (4.8%) IABP users (OR: 1.33 95%CI: 0.52–3.58). Kaplan-Meier survival curve analysis showed no significant differences between the two groups in mortality up to one year after the operation (p = 0.72). On multivariate analysis, IABP usage among the PSM patients was associated with lower 30-day mortality (OR: 0.28, 95%CI: 0.07–0.92, P-value = 0.043), 90-day mortality (OR: 0.26, 95%CI: 0.08–0.78, P-value = 0.022) and reduced risk of developing severe respiratory disorders (OR: 0.10, 95%CI:0.01–0.50, P-value = 0.011). Conclusion: Pre-operative IABP use in high-risk patients reduces 30- and 90-day mortality rates, along with a notable decrease in rates of severe respiratory disorders. coronary artery bypass grafting intra-aortic balloon pump propensity score matching in-hospital complications open heart surgery Figures Figure 1 Figure 2 Figure 3 INTRODUCTION With an aging population, healthcare professionals around the world will see more elderly patients seeking coronary bypass grafting (CABG) intervention [ 1 ]. Pre-operative Intra-aortic balloon pump (IABP) implantation was thought to reduce surgical mortality by improving hemodynamic stability and coronary perfusion [ 2 ]. However, this has become a point of contention, with newer studies observing higher mortality rates in patients receiving IABP. Notably, in the IABP-SHOCK I which is a multi-centre randomized control trial, no differences in the measured hemodynamic parameters were observed between the IABP and control group [ 3 ]. This was further demonstrated in the subsequent IABP-SHOCK II trial, where no improvements in mortality and morbidity between the control and IABP group were observed up to 6 years after revascularization by either percutaneous intervention (PCI) or surgical bypass. Moreover, comprehensive analyses involving systemic inflammation, arterial lactate, renal function, and mean arterial blood pressure have yielded inconclusive evidence, challenging the presumed pathophysiological underpinnings of IABP's role in maintaining hemodynamic stability [ 4 ]. The discordant nature of evidence persists in studies examining the effects of pre-operative IABP insertion, with a lack of consensus regarding its impact on morbidity and mortality [ 5 – 7 ]. A meta-analysis encompassing 11 studies, comparing outcomes following prophylactic IABP implementation before percutaneous coronary intervention, reported no significant clinical improvements [ 8 ]. Strikingly, a retrospective study conducted by Yu et al. even suggested an increase in in-hospital mortality and morbidity associated with IABP implantation [ 9 ]. A noteworthy gap in existing research lies in the absence of studies exploring the use of pre-operative IABP within a mixed ethnic population [ 10 – 12 ]. Thus, our study aims to bridge this gap by investigating whether prophylactic pre-operative IABP implantation among patients undergoing CABG surgery contributes to increased morbidity and mortality in the specific context of an Asian mixed-ethnicity population. METHODS This retrospective study was approved by the institutional review board (DSRB: 2016/01070) at the National Healthcare Group, Singapore. From 2009 to 2016, 2907 CABG patients at this tertiary institute were included. Maquet Datascope™ CS-100 intra-aortic balloon pumps (Getinge, Gothenburg, Sweden), with sizes of 34cc for patients below the height of 162cm and 50cc for those 162cm and above, were utilized. Post-insertion, X-rays verified proper positioning just distal to the aortic arch. Comprehensive patient data was documented and stored in the department registry. Analysis cohort Exclusion criteria included (1) patients receiving intra-operative or post-operative IABP support, (2) those at low mortality risk (logistic EuroSCORE II 1.2%, determined through a Chi-square automatic interaction detection (CHAID) Decision Tree analysis in R Studio, as depicted in Fig. 1 . Patients were then stratified into high and low-risk groups based on logistic EuroSCORE II and one-year-all-cause mortality rates. This approach was employed due to considerations that the EuroSCORE II cut-offs recommended by the American Heart Association for predicting mortality [ 13 , 14 ] were not optimal for a mixed Asian population [ 15 , 16 ]. Definitions of study outcomes This study was aimed primarily at evaluating all-cause mortality over a one-year follow-up period. The primary outcomes include short-term mortality assessed using 30-day mortality events and long-term mortality analyzed through Kaplan-Meier survival curve analysis. Secondary outcomes encompassed in-hospital events such as post-operative renal replacement therapy (RRT), cerebrovascular accidents, severe respiratory disorders, disabling complications, septicemia, infection, and the postoperative length of stay. Propensity score matching analysis We employed propensity score matching (PSM) to simulate a randomized trial. We estimated the propensity score for each individual by using logistic regression to model the probability of receiving IABP given the variables shown in Table 1 . Subsequently, IABP users were matched to non-IABP users at a 1:1 ratio using the "nearest-neighbor" method, with a matching caliper set at 0.25 × standard deviation. Individuals with propensity scores that did not permit matches within the caliper were excluded. A total of 250 pairs of IABP and non-IABP users were successfully matched, and the adequacy of the match was assessed by ensuring that all baseline covariates exhibited a standardized mean difference of < 10% (Table 1 ). The matching procedure was executed using R Studio (Integrated Development for R, Boston, MA) [ 17 ]. Table 1 Comprehensive overview of the patient population under consideration Before PSM After PSM Control IABP p Control IABP p n 1198 377 250 250 Age (median [IQR]) 65.0 [58.0, 71.0] 61.0 [55.0, 69.0] < 0.001 62.0 [55.0, 68.8] 63.0 [55.3, 69.0] 0.585 Male (%) 904 (75.5) 304 (80.6) 0.045 200 (80.0) 192 (76.8) 0.447 Race (%) 0.151 0.950 Chinese 795 (66.4) 245 (65.0) 171 (68.4) 168 (67.2) Indian 162 (13.5) 40 (10.6) 31 (12.4) 29 (11.6) Malay 209 (17.4) 83 (22.0) 42 (16.8) 46 (18.4) Others 32 (2.7) 9 (2.4) 6 (2.4) 7 (2.8) BMI (median [IQR]) 24.0 [21.8, 26.8] 24.5 [22.3, 27.1] 0.035 24.2 [22.3, 26.9] 24.4 [21.9, 27.3] 0.897 Pre-operative RRT (%) 81 (6.8) 311 (2.9%) 0.008 7 (2.8%) 8 (3.2%) 1.000 Family history of CAD (%) 65 (5.4) 23 (6.1) 0.846 19 (7.6) 17 (6.8) 0.793 Pulmonary hypertension (%) 26 (2.2) 10 (2.7) 0.727 10 (4.0) 8 (3.2) 0.81 Diabetes management (%) < 0.001 0.809 Diet 43 (3.6) 18 (4.8) 11 (4.4) 11 (4.4) Insulin 245 (20.5) 41 (10.9) 33 (13.2) 28 (11.2) Not diabetic 450 (37.6) 197 (52.3) 114 (45.6) 124 (49.6) Oral therapy 460 (38.4) 121 (32.1) 92 (36.8) 87 (34.8) Morbid obesity (%) 16 (1.3) 2 (0.5) 0.315 2 (0.8) 2 (0.8) 1.000 Last creatinine level (median [IQR]) 92.0 [75.0, 121.0] 85.0 [70.0, 114.0] 0.002 88.5 [74.3, 112.0] 84.0 [71.0, 112.5] 0.224 Hypertension (%) < 0.001 0.654 No 168 (14.0) 104 (27.6) 59 (23.6) 51 (20.4) Treated or BP greater than 140/90 1030 (86.0) 273 (72.4) 191 (76.4) 199 (79.6) Peripheral vascular disease (%) 173 (14.4) 25 (6.6) < 0.001 21 (8.4) 19 (7.6) 0.869 Carotid disease (%) 146 (12.2) 33 (8.8) 0.082 24 (9.6) 29 (11.6) 0.561 Extracardiac arteriopathy (%) 284 (23.7) 55 (14.6) < 0.001 40 (16.0) 45 (18.0) 0.634 Extensive atherosclerosis (%) 129 (10.8) 35 (9.3) 0.468 16 (6.4) 22 (8.8) 0.399 Previous percutaneous intervention (%) 247 (20.6) 76 (20.2) 0.905 48 (19.2) 40 (16.0) 0.411 Inotropic support (%) 5 (0.4) 42 (11.1) < 0.001 4 (1.6) 5 (2.0) 1.000 Ventilated preoperatively (%) 7 (0.6) 36 (9.5) < 0.001 5 (2.0) 6 (2.4) 1.000 Cardiogenic shock (%) 18 (1.5) 56 (14.9) < 0.001 12 (4.8) 15 (6.0) 0.692 Hemodynamic instability (%) 10 (0.8) 53 (14.1) < 0.001 6 (2.4) 11 (4.4) 0.324 Cardiomegaly (%) 8 (0.7) 3 (0.8) 0.186 1 (0.4) 1 (0.4) 0.919 No 917 (76.5) 271 (71.9) 103 (27.3) 187 (74.8) 183 (73.2) Yes 273 (22.8) 62 (24.8) 66 (26.4) Number of previous MI (%) < 0.001 0.964 None 410 (34.2) 78 (20.7) 62 (24.8) 59 (23.6) One 637 (53.2) 256 (67.9) 156 (62.4) 159 (63.6) Two or more 151 (12.6) 43 (11.4) 32 (12.8) 32 (12.8) Congestive heart failure = Yes (%) 276 (23.0) 132 (35.0) < 0.001 66 (26.4) 73 (29.2) 0.549 Angina (%) < 0.001 0.555 None 434 (36.2) 73 (19.4) 59 (23.6) 58 (23.2) Stable 605 (50.5) 114 (30.2) 108 (43.2) 98 (39.2) Unstable 159 (13.3) 190 (50.4) 83 (33.2) 94 (37.6) Resus = Yes (%) 16 (1.3) 35 (9.3) < 0.001 10 (4.0) 11 (4.4) 1.000 Preoperative heart rhythm (%) < 0.001 0.868 Atrial fibrillation/flutter 53 (4.4) 19 (5.0) 10 (4.0) 13 (5.2) Complete heart block/pacing 7 (0.6) 3 (0.8) 2 (0.8) 3 (1.2) Other abnormal rhythm 14 (1.2) 8 (2.1) 4 (1.6) 3 (1.2) Sinus rhythm 1103 (92.1) 325 (86.2) 224 (89.6) 224 (89.6) VT or VF 21 (1.8) 22 (5.8) 10 (4.0) 7 (2.8) Dyspnoea (%) < 0.001 0.933 1 or 2 1068 (89.1) 286 (75.9) 210 (84.0) 207 (82.8) 3 122 (10.2) 76 (20.2) 37 (14.8) 40 (16.0) 4 8 (0.7) 15 (4.0) 3 (1.2) 3 (1.2) Extent of coronary artery disease (%) 0.042 0.143 No vessel with > 50% stenosis 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) One vessel with > 50% stenosis 35 (2.9) 3 (0.8) 2 (0.8) 2 (0.8) Three vessels with > 50% stenosis 957 (79.9) 296 (78.5) 200 (80.0) 206 (82.4) Two vessels with > 50% stenosis 206 (17.2) 78 (20.7) 48 (19.2) 42 (16.8) No LMS disease / LMS disease < 51% stenosis (%) 893 (74.5) 147 (39.0) < 0.001 117 (46.8) 119 (47.6) 0.929 Ejection fraction (median [IQR]) 50.0 [38.0, 60.0] 40.0 [30.0, 55.0] < 0.001 45.0 [35.0, 55.0] 44.5 [30.5, 55.0] 0.535 DD = Yes (%) 435 (36.3) 132 (35.0) 0.692 85 (34.0) 83 (33.2) 0.925 RWMA = Yes (%) 785 (65.5) 264 (70.0) 0.12 174 (69.6) 172 (68.8) 0.923 Reoperation = Yes (%) 7 (0.6) 3 (0.8) 0.937 3 (1.2) 2 (0.8) 1.000 Operative urgency (%) < 0.001 0.914 Elective 694 (57.9) 58 (15.4) 54 (21.6) 51 (20.4) Emergency 67 (5.6) 87 (23.1) 36 (14.4) 36 (14.4) Salvage 0 (0.0) 7 (1.9) 0 (0.0) 0 (0.0) Urgent 437 (36.5) 225 (59.7) 160 (64.0) 163 (65.2) CABG Category (%) 0.001 0.901 Off-pump isolated CABG 74 (6.2) 5 (1.3) 3 (1.2) 3 (1.2) On-pump beating heart isolated CABG 54 (4.5) 18 (4.8) 9 (3.6) 11 (4.4) On-pump isolated CABG 1070 (89.3) 354 (93.9) 238 (95.2) 236 (94.4) IQR = Inter quartile range; CAD = coronary artery disease; CABG = Coronary artery bypass graft; BMI = Body mass index; MI = Myocardial infarction; RRT = Renal replacement therapy; VT or VF = Ventricular tachycardia or Ventricular fibrillation; DD = Diastolic dysfunction; RWMA = Regional wall motion abnormality; LMS = Left main stem Statistical analysis In the pre-matched cohort, categorical variables were expressed as frequencies and percentages. Normality of continuous variables was assessed using Shapiro-Wilk’s method. Normally distributed continuous variables were presented as mean and standard deviations, while non-normally distributed ones were represented as median and inter-quantile range. Stratification by IABP usage allowed comparisons using the Mann-Whitney U test for continuous variables and the Chi-square test for categorical variables. Paired univariate analysis was conducted for the two groups. Categorical variables were compared using McNemar’s Test, and continuous variables were compared using paired T test. Kaplan-Meier survival curve analysis was performed using the signed-rank test. All statistical analyses were carried out using R Studio, with a significance threshold set at p-value < 0.05 [ 17 ]. RESULTS This retrospective study focused on patients undergoing CABG between 2009 and 2016. The patient cohort, consisting of 2907 individuals, was refined by excluding those who received intra-operative or post-operative IABP support, low-risk patients (EuroSCORE II < 1.2%), and those with missing information. The final pre-matched cohort comprised 1575 individuals, categorized into 1198 non-IABP users and 377 pre-operative IABP users (Supplementary Fig. 1). Table 1 presents a comprehensive overview of patient characteristics both before and after PSM. Prior to PSM, patients with pre-operative IABP insertion exhibited higher median age, male predominance, body mass index (BMI), serum creatinine levels, and ejection fractions. All patient characteristics were generally elevated in the pre-operative IABP group, with some exceptions such as preoperative RRT, diabetes, hypertension, peripheral vascular disease, and extracardiac arteriopathy. After PSM, the matching protocol successfully balanced baseline covariates between the two groups, as indicated by standardized mean differences < 10%. No significant differences were found in patient characteristics post-matching, ensuring a more comparable and balanced comparison between non-IABP and pre-operative IABP users (Supplementary Fig. 2). These findings provided a robust foundation for subsequent analyses and interpretations of the study outcomes. Study outcomes Mortality : Table 2 presents the mortality rates in the PSM cohort, revealing no significant differences in 30-day, 90-day, and 1-year mortality rates between the groups. Specifically, 30-day mortality occurred in 9 (3.6%) non-IABP users and 12 (4.8%) IABP users, with an odds ratio (OR) of 1.33 (95%CI: 0.52–3.58). Kaplan-Meier survival curve analysis (Fig. 2 ) indicated no noteworthy disparities in mortality up to one-year post-operation (p = 0.72). In the multivariate analysis, IABP usage in the PSM group demonstrated an association with lower 30-day mortality (OR: 0.28, 95%CI: 0.07–0.92, P-value = 0.043) and 90-day mortality (OR: 0.26, 95%CI: 0.08–0.78, P-value = 0.022) rates (Fig. 3 ). Table 2 Primary and secondary outcomes of the study Primary Outcomes Control IABP OR (95% CI) p-value 30-day mortality 9 (3.6%) 12 (4.8%) 1.33 (0.52–3.58) 0.663 90-day mortality 14 (5.6%) 14 (5.6%) 1.00 (0.44–2.24) 0.850 1-year mortality 16 (6.4%) 18 (7.2%) 0.89 (0.42–1.85) 0.864 Secondary Outcomes Control IABP OR (95% CI) p-value Renal replacement therapy 17 (6.8%) 12 (4.8%) 0.71 (0.31–1.57) 0.458 Cerebrovascular accidents 10 (4.0%) 3 (1.2%) 0.30 (0.05–1.17) 0.096 Severe respiratory disorder a 11 (4.4%) 4 (1.6%) 0.36 (0.08–1.23) 0.121 Disabling complications b 29 (11.6%) 14 (5.6%) 0.48 (0.24–0.94) 0.033 Septicaemia 5 (2.0%) 8 (3.2%) 1.60 (0.46–6.22) 0.579 Infection c 26 (10.4%) 31 (12.4%) 1.20 (0.69–2.09) 0.600 Secondary Outcome Control IABP Mean Difference (95%CI) p-value Post-operative length of stay (days) [IQR] 8.0 [6.0–12.0] 9.0 [7.0–14.8] 1.32 (-0.82–3.47) 0.225 a Severe respiratory disorder secondary to pulmonary embolism, pulmonary edema, pneumonia, acute respiratory distress syndrome, or respiratory failure requiring ventilation. b Defined as debilitating complications causing severe disability, consisting of cerebrovascular stroke, coma, renal insufficiency requiring renal replacement therapy, and severe respiratory disorders. c Defined as an infection of the leg, mediastinum, sternum, urinary tract, or septicemia. Secondary outcomes : In Table 2 , IABP-treated patients had a lower likelihood of disabling complications (OR = 0.48, 95%CI: 0.24–0.94) without observed IABP site-related infections. The IABP group showed fewer instances of renal insufficiency requiring RRT, cerebrovascular accidents, disabling complications, and severe respiratory disorders (Fig. 3 A). In the multivariate analysis (Fig. 3 B), IABP use was associated with decreased risk of severe respiratory disorders (OR: 0.10, 95%CI: 0.01–0.50, P-value = 0.011), lower 30-day and 90-day mortality, and improved outcomes for 1-year mortality, RRT, cerebrovascular accidents, severe respiratory disorders, and disabling complications. DISCUSSION A lower threshold for initiating IABP support was observed due to the higher risk profile of patients undergoing CABG, with 31% utilizing IABP. While IABP showed no survival benefit in high-risk (EuroSCORE II > 1.2%) patients, it did reduce the risk of disabling complications and short-term mortality, a new observation not highlighted in previous studies. Despite the absence of a long-term mortality reduction, the improvement in short-term outcomes justifies IABP usage, as it significantly enhances patients' quality of life [ 4 , 18 ]. IABP improves patient outcomes by reducing afterload via enhancing diastolic and lowering systolic aortic pressures. This results in lowered left ventricular wall stress and, hence, decreased demand for oxygen by the myocardium. Moreover, IABP concomitantly improves cardiac output by raising cardiac stroke volume, especially in patients with impaired left ventricular function. This, in turn, increases renal blood flow and improves renal function [ 19 – 22 ]. However, there is still much controversy surrounding the effects of pre-operative IABP implantation on post-operative outcomes. While many studies have pointed out the strong association between pre-operative IABP insertion and high postoperative mortality and morbidity [ 9 , 11 ], the increased adverse events might be attributed to the presence of confounders. Conflicting results in studies may stem from significant heterogeneity between non-IABP and IABP groups, with surgeons favorably selecting higher pre-operative risk patients for IABP insertion, introducing selection bias [ 4 ]. Robust randomized control trials or propensity-score matching studies can mitigate this bias. Lack of consensus in the surgical community on the definition of high-risk patients further complicates the issue. While our study used EuroSCORE II > 1.2%, others defined high-risk patients using various clinical variables [ 14 , 23 , 24 ]. Notably, the generalizability of IABP effects from studies like SHOCK II to bypass surgery patients is questioned [ 18 ]. Future research should focus on establishing a standardized criterion for defining high-risk patients benefiting from pre-operative IABP. Additionally, population and demographic factors, particularly in mixed Asian populations, remain understudied and may contribute to varied outcomes. Limitation This study has limitations. Firstly, reliance on surgical registry data limits access to specific clinical details. Secondly, despite an 8-year duration and over 2900 patients, the small number of pre-operative IABP users and low event rate may yield statistically insignificant secondary outcomes. Thirdly, despite rigorous propensity-score matching, potential residual variables could introduce confounding effects. Lastly, as a single-center study, variations in IABP practices across centers were not considered. A large-scale multi-center randomized control trial is needed for comprehensive validation. CONCLUSION Using pre-operative IABP in high-risk patients (EuroSCORE II > 1.2%) significantly reduces 30-day and 90-day mortality rates. Additionally, it correlates with a lower incidence of severe respiratory disorders, emphasizing the potential benefits for high-risk patients by enhancing short-term outcomes and respiratory well-being. GLOSSARY OF ABBREVIATIONS BMI: Body mass index CABG: Coronary artery bypass grafting CHAID: Chi-square automatic interaction detection DSRB: Domain specific review board EuroSCORE: European system for cardiac operative risk evaluation IABP: Intra-aortic balloon pump NUH: National University Hospital OR: Odds ratio PCI: Percutaneous intervention PSM: Propensity score matching RRT: Renal replacement therapy SHOCK: Should we emergently revascularize occluded coronaries for cardiogenic shock DECLARATIONS Author Contributions: Conceptualization, F.S., H.L., G.C., D.W., Z.X., T.K., and G.K.; Methodology, D.W., Z.X., F.S., and H.L.; Software, D.W., Z.X., and F.S.; Validation, G.C., H.L., D.W., and F.S.; Formal analysis, D.W., Z.X., and F.S.; Data curation, D.W., Z.X., and F.S.; Writing—original draft preparation, F.S., H.L., G.C., D.W., Z.X., T.K., and G.K.; Writing—review and editing, F.S., H.L., G.C., D.W., Z.X., T.K., and G.K.; Visualization, D.W., Z.X., and F.S.; Resources, T.K., and G.C.; Supervision, F.S., and G.K.; Project administration, H.L., and F.S.; Funding acquisition, T.K., and G.K. All authors have read and agreed to the final version of the manuscript. Funding: This research was not funded. Acknowledgment: The authors are thankful for the valuable contribution of Ms Cheryl Lim (NUH, Singapore). Conflicts of Interest: The author declares no conflict of interest. Informed Consent Statement: Retrospective study, informed consent was waived. Data Availability Statement: The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials. Raw data were generated at Cardiac Surgery Research Laboratory at the National University of Singapore. Derived data supporting the findings of this study are available from the corresponding author on request. Clinical registration number: DSRB:2016/01070 REFERENCES Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Cheng, S., Chiuve, S. E., Cushman, M., Delling, F. N., Deo, R., de Ferranti, S. D., Ferguson, J. 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European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 38(5), 585–591. https://doi.org/10.1016/j.ejcts.2010.03.017 Kunt, A. G., Kurtcephe, M., Hidiroglu, M., Cetin, L., Kucuker, A., Bakuy, V., Akar, A. R., & Sener, E. (2013). Comparison of original EuroSCORE, EuroSCORE II and STS risk models in a Turkish cardiac surgical cohort. Interactive cardiovascular and thoracic surgery , 16(5), 625–629. https://doi.org/10.1093/icvts/ivt022 Nashef, S. A., Roques, F., Sharples, L. D., Nilsson, J., Smith, C., Goldstone, A. R., & Lockowandt, U. (2012). EuroSCORE II. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery , 41 (4), 734–745. https://doi.org/10.1093/ejcts/ezs043 Jamaati, H., Najafi, A., Kahe, F., Karimi, Z., Ahmadi, Z., Bolursaz, M., Masjedi, M., Velayati, A., & Hashemian, S. M. (2015). Assessment of the EuroSCORE risk scoring system for patients undergoing coronary artery bypass graft surgery in a group of Iranian patients. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine , 19(10), 576–579. https://doi.org/10.4103/0972-5229.167033 Kar, P., Geeta, K., Gopinath, R., & Durga, P. (2017). Mortality prediction in Indian cardiac surgery patients: Validation of European System for Cardiac Operative Risk Evaluation II. Indian journal of anaesthesia , 61 (2), 157–162. https://doi.org/10.4103/ija.IJA_522_16 R-studio, integrated programming language for statistical computing and graphics, Developed by Posit, PBC. Available online from: https://posit.co/products/open-source/rstudio/ [Accessed on January 03, 2024] Thiele, H., Zeymer, U., Neumann, F. J., Ferenc, M., Olbrich, H. G., Hausleiter, J., de Waha, A., Richardt, G., Hennersdorf, M., Empen, K., Fuernau, G., Desch, S., Eitel, I., Hambrecht, R., Lauer, B., Böhm, M., Ebelt, H., Schneider, S., Werdan, K., Schuler, G., … Intraaortic Balloon Pump in cardiogenic shock II (IABP-SHOCK II) trial investigators (2013). Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet (London, England) , 382 (9905), 1638–1645. https://doi.org/10.1016/S0140-6736(13)61783-3 Yoshimura, S., Kiguchi, T., Irisawa, T., Yamada, T., Yoshiya, K., Park, C., Nishimura, T., Ishibe, T., Kobata, H., Kishimoto, M., Kim, S. H., Ito, Y., Sogabe, T., Morooka, T., Sakamoto, H., Suzuki, K., Onoe, A., Matsuyama, T., Matsui, S., Nishioka, N., … Iwami, T. (2023). Intra-Aortic Balloon Pump among Shockable Out-of-Hospital Cardiac Arrest Patients: A Propensity-Weighted Analysis in a Multicenter, Nationwide Observational Study in Japan (The JAAM-OHCA Registry). Journal of clinical medicine , 12(18), 5945. https://doi.org/10.3390/jcm12185945 Somaschini, A., Cornara, S., Leonardi, S., Demarchi, A., Mandurino-Mirizzi, A., Fortuni, F., Ferlini, M., Crimi, G., Camporotondo, R., Gnecchi, M., Oltrona Visconti, L., De Servi, S., & De Ferrari, G. M. (2023). Beneficial Effects of IABP in Anterior Myocardial Infarction Complicated by Cardiogenic Shock. Medicina (Kaunas, Lithuania) , 59(10), 1806. https://doi.org/10.3390/medicina59101806 Sundermeyer, J., Kellner, C., Beer, B. N., Besch, L., Dettling, A., Bertoldi, L. F., Blankenberg, S., Dauw, J., Dindane, Z., Eckner, D., Eitel, I., Graf, T., Horn, P., Jozwiak-Nozdrzykowska, J., Kirchhof, P., Kluge, S., Linke, A., Landmesser, U., Luedike, P., Lüsebrink, E., … Schrage, B. (2023). Association between left ventricular ejection fraction, mortality and use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock. Clinical research in cardiology : official journal of the German Cardiac Society , 10.1007/s00392-023-02332-y. Advance online publication. https://doi.org/10.1007/s00392-023-02332-y Li, M., Hu, L., & Li, L. (2023). Research progress of intra-aortic balloon counterpulsation in the treatment of acute myocardial infarction with cardiogenic shock: A review. Medicine , 102 (49), e36500. https://doi.org/10.1097/MD.0000000000036500 Pilarczyk, K., Boening, A., Jakob, H., Langebartels, G., Markewitz, A., Haake, N., Heringlake, M., & Trummer, G. (2016). Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials†. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 49(1), 5–17. https://doi.org/10.1093/ejcts/ezv258 Escutia-Cuevas H. H. (2021). Use of intra-aortic balloon pump during coronary artery bypass graft surgery. Current questions and few answers. Journal of cardiac surgery , 36 (4), 1466–1467. https://doi.org/10.1111/jocs.15436 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3960669","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":273584924,"identity":"6960a78e-6346-4e3e-aa44-61b036ffc575","order_by":0,"name":"Faizus Sazzad","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYLCCCgYbCIOHaC1nGNJI13KYBC3yM3Kfbjjw53yewfkDjA/etjHYyzsQ0GJwI93sxsG228UGNxKYDee2MSRuPEBIi0Qa2+2PDbcTN9xgYJPmbWNIMGwg6LA0thsH/pxL3HD+APtvoBZ7gloYboC0sB1I3HAggY0ZqIVxPiEdBmeesQH9kpw480Zis+SccxKJGwhpkW8HO8wuse/84YMf3pTZ2MsTdBgCMILUSjAYHCBeC8xeEmwZBaNgFIyCkQEAbO9GaP95esEAAAAASUVORK5CYII=","orcid":"","institution":"National University of Singapore","correspondingAuthor":true,"prefix":"","firstName":"Faizus","middleName":"","lastName":"Sazzad","suffix":""},{"id":273584925,"identity":"d32e921d-46e3-4207-9285-ef5fa5fd2bac","order_by":1,"name":"Hai Dong Luo","email":"","orcid":"","institution":"National University Heart Centre","correspondingAuthor":false,"prefix":"","firstName":"Hai","middleName":"Dong","lastName":"Luo","suffix":""},{"id":273584926,"identity":"078b92e9-9ea1-4127-bceb-9c49ad94d6ce","order_by":2,"name":"Guohao Chang","email":"","orcid":"","institution":"National University Heart Centre","correspondingAuthor":false,"prefix":"","firstName":"Guohao","middleName":"","lastName":"Chang","suffix":""},{"id":273584927,"identity":"3d696f31-80e9-4e2e-9ebb-9643fb847362","order_by":3,"name":"Duoduo Wu","email":"","orcid":"","institution":"National University of Singapore","correspondingAuthor":false,"prefix":"","firstName":"Duoduo","middleName":"","lastName":"Wu","suffix":""},{"id":273584928,"identity":"02c08b96-f433-4484-ac63-1f8668d02f4f","order_by":4,"name":"Zhi Xian Ong","email":"","orcid":"","institution":"National University of Singapore","correspondingAuthor":false,"prefix":"","firstName":"Zhi","middleName":"Xian","lastName":"Ong","suffix":""},{"id":273584929,"identity":"29dd2d0d-79ff-4df3-8879-6b6bf04c0f37","order_by":5,"name":"Theo Kofidis","email":"","orcid":"","institution":"National University of Singapore","correspondingAuthor":false,"prefix":"","firstName":"Theo","middleName":"","lastName":"Kofidis","suffix":""},{"id":273584930,"identity":"c7f9c5f5-aabf-417e-aec1-0c803d439c47","order_by":6,"name":"Giap Swee Kang","email":"","orcid":"","institution":"National University of Singapore","correspondingAuthor":false,"prefix":"","firstName":"Giap","middleName":"Swee","lastName":"Kang","suffix":""}],"badges":[],"createdAt":"2024-02-16 08:03:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3960669/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3960669/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51442318,"identity":"8347f2ac-8f6f-490b-b30c-6fa81aee5837","added_by":"auto","created_at":"2024-02-21 17:51:49","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":60144,"visible":true,"origin":"","legend":"\u003cp\u003eChi-square automatic interaction detection (CHAID) Decision Tree analysis showing the steps of determination of the “high-risk” group; it was identified based on a logistic EuroSCORE II greater than 1.2%\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3960669/v1/64728e763466c47934f793a6.jpg"},{"id":51443298,"identity":"1b6f388a-2cdf-4aca-9ee3-5f412681a742","added_by":"auto","created_at":"2024-02-21 17:59:49","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":41948,"visible":true,"origin":"","legend":"\u003cp\u003eThe Kaplan-Meier survival curve shows the probability of survival over time for patients who underwent propensity-score-matched IABP usage compared to the control group after CABG. The curve indicates that there were no significant differences in mortality rates between the two groups up to one year after the operation, as evidenced by the overlapping survival curves.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3960669/v1/7fc9f73a5d04e89cdaaa012f.jpg"},{"id":51442319,"identity":"0b4185df-9b97-4801-a0fc-330fa9162b4d","added_by":"auto","created_at":"2024-02-21 17:51:49","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":357381,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot showing (\u003cstrong\u003eA\u003c/strong\u003e) Mcnemar’s test – IABP usage among the PSM patients had better outcomes for 1-year mortality, Renal replacement therapy, Cerebrovascular accidents, Severe respiratory disorders, and disabling complications (\u003cstrong\u003eB\u003c/strong\u003e) multivariate analysis result on IABP usage among the PSM patients was associated with lower 30-day mortality and 90-day mortality rates, in addition to better 1-year mortality, Renal replacement therapy, Cerebrovascular accidents, Severe respiratory disorders, and disabling complications. (*If the upper limit of 95% CI exceeds 2.5, it is represented by an arrow.)\u003c/p\u003e","description":"","filename":"Figure3A.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3960669/v1/5dc91d33c248a68bac82bda1.jpg"},{"id":51444778,"identity":"01655178-a6d2-44da-92f4-3a1365c3eef5","added_by":"auto","created_at":"2024-02-21 18:07:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":556770,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3960669/v1/85ceb224-7d57-4b51-b4cc-6c32d103cdb9.pdf"},{"id":51442320,"identity":"4b1af9af-14d4-483d-80b0-3a280ad7f3f1","added_by":"auto","created_at":"2024-02-21 17:51:49","extension":"jpg","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":53080,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFigure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3960669/v1/28a18cf0df64c966d362c894.jpg"},{"id":51442321,"identity":"72dc5677-b9dc-41bd-97c4-b93b57495565","added_by":"auto","created_at":"2024-02-21 17:51:49","extension":"jpg","order_by":8,"title":"","display":"","copyAsset":false,"role":"supplement","size":127726,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFigure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3960669/v1/34a1e969ed5eaf90a55402c6.jpg"}],"financialInterests":"No competing interests reported.","formattedTitle":"Pre-operative intra-aortic balloon pump insertion in coronary artery bypass grafting patients reduces in-hospital morbidity ","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eWith an aging population, healthcare professionals around the world will see more elderly patients seeking coronary bypass grafting (CABG) intervention [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Pre-operative Intra-aortic balloon pump (IABP) implantation was thought to reduce surgical mortality by improving hemodynamic stability and coronary perfusion [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, this has become a point of contention, with newer studies observing higher mortality rates in patients receiving IABP. Notably, in the IABP-SHOCK I which is a multi-centre randomized control trial, no differences in the measured hemodynamic parameters were observed between the IABP and control group [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This was further demonstrated in the subsequent IABP-SHOCK II trial, where no improvements in mortality and morbidity between the control and IABP group were observed up to 6 years after revascularization by either percutaneous intervention (PCI) or surgical bypass. Moreover, comprehensive analyses involving systemic inflammation, arterial lactate, renal function, and mean arterial blood pressure have yielded inconclusive evidence, challenging the presumed pathophysiological underpinnings of IABP's role in maintaining hemodynamic stability [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe discordant nature of evidence persists in studies examining the effects of pre-operative IABP insertion, with a lack of consensus regarding its impact on morbidity and mortality [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A meta-analysis encompassing 11 studies, comparing outcomes following prophylactic IABP implementation before percutaneous coronary intervention, reported no significant clinical improvements [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Strikingly, a retrospective study conducted by Yu et al. even suggested an increase in in-hospital mortality and morbidity associated with IABP implantation [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA noteworthy gap in existing research lies in the absence of studies exploring the use of pre-operative IABP within a mixed ethnic population [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Thus, our study aims to bridge this gap by investigating whether prophylactic pre-operative IABP implantation among patients undergoing CABG surgery contributes to increased morbidity and mortality in the specific context of an Asian mixed-ethnicity population.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e This retrospective study was approved by the institutional review board (DSRB: 2016/01070) at the National Healthcare Group, Singapore. From 2009 to 2016, 2907 CABG patients at this tertiary institute were included. Maquet Datascope\u0026trade; CS-100 intra-aortic balloon pumps (Getinge, Gothenburg, Sweden), with sizes of 34cc for patients below the height of 162cm and 50cc for those 162cm and above, were utilized. Post-insertion, X-rays verified proper positioning just distal to the aortic arch. Comprehensive patient data was documented and stored in the department registry.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis cohort\u003c/h2\u003e \u003cp\u003eExclusion criteria included (1) patients receiving intra-operative or post-operative IABP support, (2) those at low mortality risk (logistic EuroSCORE II\u0026thinsp;\u0026lt;\u0026thinsp;1.2%), and (3) individuals with incomplete information. Eligible individuals were categorized into IABP and non-IABP (control) groups. High mortality risk was defined by logistic EuroSCORE II\u0026thinsp;\u0026gt;\u0026thinsp;1.2%, determined through a Chi-square automatic interaction detection (CHAID) Decision Tree analysis in R Studio, as depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Patients were then stratified into high and low-risk groups based on logistic EuroSCORE II and one-year-all-cause mortality rates. This approach was employed due to considerations that the EuroSCORE II cut-offs recommended by the American Heart Association for predicting mortality [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] were not optimal for a mixed Asian population [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eDefinitions of study outcomes\u003c/h2\u003e \u003cp\u003eThis study was aimed primarily at evaluating all-cause mortality over a one-year follow-up period. The primary outcomes include short-term mortality assessed using 30-day mortality events and long-term mortality analyzed through Kaplan-Meier survival curve analysis. Secondary outcomes encompassed in-hospital events such as post-operative renal replacement therapy (RRT), cerebrovascular accidents, severe respiratory disorders, disabling complications, septicemia, infection, and the postoperative length of stay.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePropensity score matching analysis\u003c/h2\u003e \u003cp\u003eWe employed propensity score matching (PSM) to simulate a randomized trial. We estimated the propensity score for each individual by using logistic regression to model the probability of receiving IABP given the variables shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Subsequently, IABP users were matched to non-IABP users at a 1:1 ratio using the \"nearest-neighbor\" method, with a matching caliper set at 0.25 \u0026times; standard deviation. Individuals with propensity scores that did not permit matches within the caliper were excluded. A total of 250 pairs of IABP and non-IABP users were successfully matched, and the adequacy of the match was assessed by ensuring that all baseline covariates exhibited a standardized mean difference of \u0026lt;\u0026thinsp;10% (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The matching procedure was executed using R Studio (Integrated Development for R, Boston, MA) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComprehensive overview of the patient population under consideration\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBefore PSM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eAfter PSM\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIABP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIABP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (median [IQR])\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65.0 [58.0, 71.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.0 [55.0, 69.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e62.0 [55.0, 68.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e63.0 [55.3, 69.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.585\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e904 (75.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e304 (80.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e200 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e192 (76.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.447\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.950\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChinese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e795 (66.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e245 (65.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e171 (68.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e168 (67.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e162 (13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29 (11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e209 (17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (22.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42 (16.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e46 (18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (median [IQR])\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.0 [21.8, 26.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.5 [22.3, 27.1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.2 [22.3, 26.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24.4 [21.9, 27.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.897\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-operative RRT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e311 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (2.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (3.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily history of CAD (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary hypertension (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes management (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.809\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsulin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e245 (20.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28 (11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot diabetic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e450 (37.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e197 (52.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e114 (45.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e124 (49.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e460 (38.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121 (32.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e92 (36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e87 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMorbid obesity (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLast creatinine level (median [IQR])\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92.0 [75.0, 121.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.0 [70.0, 114.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88.5 [74.3, 112.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e84.0 [71.0, 112.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.224\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.654\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e168 (14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104 (27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59 (23.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e51 (20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreated or BP greater than 140/90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1030 (86.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e273 (72.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e191 (76.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e199 (79.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeripheral vascular disease (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e173 (14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.869\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarotid disease (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e146 (12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29 (11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.561\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtracardiac arteriopathy (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e284 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45 (18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.634\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtensive atherosclerosis (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.399\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious percutaneous intervention (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e247 (20.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76 (20.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.905\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48 (19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40 (16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.411\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInotropic support (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVentilated preoperatively (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiogenic shock (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.692\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemodynamic instability (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.324\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiomegaly (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.919\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e917 (76.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e271 (71.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e103 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e187 (74.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e183 (73.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e273 (22.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e62 (24.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66 (26.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eNumber of previous MI (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.964\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e410 (34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (20.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e62 (24.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e59 (23.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e637 (53.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e256 (67.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e156 (62.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e159 (63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwo or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e151 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32 (12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32 (12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCongestive heart failure\u0026thinsp;=\u0026thinsp;Yes (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e276 (23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132 (35.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66 (26.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e73 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.549\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAngina (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.555\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e434 (36.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59 (23.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e58 (23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e605 (50.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114 (30.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e108 (43.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e98 (39.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnstable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e159 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e190 (50.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e83 (33.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e94 (37.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResus\u0026thinsp;=\u0026thinsp;Yes (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003ePreoperative heart rhythm (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.868\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtrial fibrillation/flutter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplete heart block/pacing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther abnormal rhythm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSinus rhythm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1103 (92.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e325 (86.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e224 (89.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e224 (89.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVT or VF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyspnoea (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.933\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 or 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1068 (89.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e286 (75.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e210 (84.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e207 (82.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76 (20.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37 (14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40 (16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtent of coronary artery disease (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.143\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo vessel with \u0026gt;\u0026thinsp;50% stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne vessel with \u0026gt;\u0026thinsp;50% stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThree vessels with \u0026gt;\u0026thinsp;50% stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e957 (79.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e296 (78.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e200 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e206 (82.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwo vessels with \u0026gt;\u0026thinsp;50% stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e206 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (20.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48 (19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42 (16.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo LMS disease / LMS disease\u0026thinsp;\u0026lt;\u0026thinsp;51% stenosis (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e893 (74.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e147 (39.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e117 (46.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e119 (47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.929\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEjection fraction (median [IQR])\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.0 [38.0, 60.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.0 [30.0, 55.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45.0 [35.0, 55.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44.5 [30.5, 55.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.535\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDD\u0026thinsp;=\u0026thinsp;Yes (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e435 (36.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132 (35.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.692\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85 (34.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e83 (33.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.925\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRWMA\u0026thinsp;=\u0026thinsp;Yes (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e785 (65.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e264 (70.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e174 (69.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e172 (68.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.923\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReoperation\u0026thinsp;=\u0026thinsp;Yes (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.937\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative urgency (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.914\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e694 (57.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e51 (20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87 (23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36 (14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36 (14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSalvage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrgent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e437 (36.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e225 (59.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e160 (64.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e163 (65.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCABG Category (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.901\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOff-pump isolated CABG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOn-pump beating heart isolated CABG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOn-pump isolated CABG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1070 (89.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e354 (93.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e238 (95.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e236 (94.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eIQR\u0026thinsp;=\u0026thinsp;Inter quartile range; CAD\u0026thinsp;=\u0026thinsp;coronary artery disease; CABG\u0026thinsp;=\u0026thinsp;Coronary artery bypass graft; BMI\u0026thinsp;=\u0026thinsp;Body mass index; MI\u0026thinsp;=\u0026thinsp;Myocardial infarction; RRT\u0026thinsp;=\u0026thinsp;Renal replacement therapy; VT or VF\u0026thinsp;=\u0026thinsp;Ventricular tachycardia or Ventricular fibrillation; DD\u0026thinsp;=\u0026thinsp;Diastolic dysfunction; RWMA\u0026thinsp;=\u0026thinsp;Regional wall motion abnormality; LMS\u0026thinsp;=\u0026thinsp;Left main stem\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eIn the pre-matched cohort, categorical variables were expressed as frequencies and percentages. Normality of continuous variables was assessed using Shapiro-Wilk\u0026rsquo;s method. Normally distributed continuous variables were presented as mean and standard deviations, while non-normally distributed ones were represented as median and inter-quantile range. Stratification by IABP usage allowed comparisons using the Mann-Whitney U test for continuous variables and the Chi-square test for categorical variables. Paired univariate analysis was conducted for the two groups. Categorical variables were compared using McNemar\u0026rsquo;s Test, and continuous variables were compared using paired T test. Kaplan-Meier survival curve analysis was performed using the signed-rank test. All statistical analyses were carried out using R Studio, with a significance threshold set at p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThis retrospective study focused on patients undergoing CABG between 2009 and 2016. The patient cohort, consisting of 2907 individuals, was refined by excluding those who received intra-operative or post-operative IABP support, low-risk patients (EuroSCORE II\u0026thinsp;\u0026lt;\u0026thinsp;1.2%), and those with missing information. The final pre-matched cohort comprised 1575 individuals, categorized into 1198 non-IABP users and 377 pre-operative IABP users (Supplementary Fig.\u0026nbsp;1).\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e presents a comprehensive overview of patient characteristics both before and after PSM. Prior to PSM, patients with pre-operative IABP insertion exhibited higher median age, male predominance, body mass index (BMI), serum creatinine levels, and ejection fractions. All patient characteristics were generally elevated in the pre-operative IABP group, with some exceptions such as preoperative RRT, diabetes, hypertension, peripheral vascular disease, and extracardiac arteriopathy.\u003c/p\u003e\n\u003cp\u003eAfter PSM, the matching protocol successfully balanced baseline covariates between the two groups, as indicated by standardized mean differences\u0026thinsp;\u0026lt;\u0026thinsp;10%. No significant differences were found in patient characteristics post-matching, ensuring a more comparable and balanced comparison between non-IABP and pre-operative IABP users (Supplementary Fig.\u0026nbsp;2). These findings provided a robust foundation for subsequent analyses and interpretations of the study outcomes.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy outcomes\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003eMortality\u003c/em\u003e: Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents the mortality rates in the PSM cohort, revealing no significant differences in 30-day, 90-day, and 1-year mortality rates between the groups. Specifically, 30-day mortality occurred in 9 (3.6%) non-IABP users and 12 (4.8%) IABP users, with an odds ratio (OR) of 1.33 (95%CI: 0.52\u0026ndash;3.58). Kaplan-Meier survival curve analysis (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e) indicated no noteworthy disparities in mortality up to one-year post-operation (p\u0026thinsp;=\u0026thinsp;0.72). In the multivariate analysis, IABP usage in the PSM group demonstrated an association with lower 30-day mortality (OR: 0.28, 95%CI: 0.07\u0026ndash;0.92, P-value\u0026thinsp;=\u0026thinsp;0.043) and 90-day mortality (OR: 0.26, 95%CI: 0.08\u0026ndash;0.78, P-value\u0026thinsp;=\u0026thinsp;0.022) rates (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ePrimary and secondary outcomes of the study\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePrimary Outcomes\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eControl\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eIABP\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR (95% CI)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30-day mortality\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9 (3.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 (4.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.33 (0.52\u0026ndash;3.58)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.663\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e90-day mortality\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14 (5.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14 (5.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00 (0.44\u0026ndash;2.24)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.850\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1-year mortality\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16 (6.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18 (7.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.89 (0.42\u0026ndash;1.85)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.864\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSecondary Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIABP\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRenal replacement therapy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17 (6.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 (4.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.71 (0.31\u0026ndash;1.57)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.458\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCerebrovascular accidents\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10 (4.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (1.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.30 (0.05\u0026ndash;1.17)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.096\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSevere respiratory disorder\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11 (4.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (1.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.36 (0.08\u0026ndash;1.23)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.121\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDisabling complications\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29 (11.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14 (5.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.48 (0.24\u0026ndash;0.94)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.033\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSepticaemia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (2.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (3.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.60 (0.46\u0026ndash;6.22)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.579\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInfection\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26 (10.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31 (12.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.20 (0.69\u0026ndash;2.09)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.600\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSecondary Outcome\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIABP\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMean Difference (95%CI)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePost-operative length of stay (days) [IQR]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.0 [6.0\u0026ndash;12.0]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.0 [7.0\u0026ndash;14.8]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.32 (-0.82\u0026ndash;3.47)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.225\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e \u003cem\u003eSevere respiratory disorder secondary to pulmonary embolism, pulmonary edema, pneumonia, acute respiratory distress syndrome, or respiratory failure requiring ventilation.\u003c/em\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e\u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e \u003cem\u003eDefined as debilitating complications causing severe disability, consisting of cerebrovascular stroke, coma, renal insufficiency requiring renal replacement therapy, and severe respiratory disorders.\u003c/em\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e \u003cem\u003eDefined as an infection of the leg, mediastinum, sternum, urinary tract, or septicemia.\u003c/em\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003eSecondary outcomes\u003c/em\u003e: In Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, IABP-treated patients had a lower likelihood of disabling complications (OR\u0026thinsp;=\u0026thinsp;0.48, 95%CI: 0.24\u0026ndash;0.94) without observed IABP site-related infections. The IABP group showed fewer instances of renal insufficiency requiring RRT, cerebrovascular accidents, disabling complications, and severe respiratory disorders (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eA). In the multivariate analysis (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eB), IABP use was associated with decreased risk of severe respiratory disorders (OR: 0.10, 95%CI: 0.01\u0026ndash;0.50, P-value\u0026thinsp;=\u0026thinsp;0.011), lower 30-day and 90-day mortality, and improved outcomes for 1-year mortality, RRT, cerebrovascular accidents, severe respiratory disorders, and disabling complications.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eA lower threshold for initiating IABP support was observed due to the higher risk profile of patients undergoing CABG, with 31% utilizing IABP. While IABP showed no survival benefit in high-risk (EuroSCORE II\u0026thinsp;\u0026gt;\u0026thinsp;1.2%) patients, it did reduce the risk of disabling complications and short-term mortality, a new observation not highlighted in previous studies. Despite the absence of a long-term mortality reduction, the improvement in short-term outcomes justifies IABP usage, as it significantly enhances patients' quality of life [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eIABP improves patient outcomes by reducing afterload via enhancing diastolic and lowering systolic aortic pressures. This results in lowered left ventricular wall stress and, hence, decreased demand for oxygen by the myocardium. Moreover, IABP concomitantly improves cardiac output by raising cardiac stroke volume, especially in patients with impaired left ventricular function. This, in turn, increases renal blood flow and improves renal function [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, there is still much controversy surrounding the effects of pre-operative IABP implantation on post-operative outcomes. While many studies have pointed out the strong association between pre-operative IABP insertion and high postoperative mortality and morbidity [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e], the increased adverse events might be attributed to the presence of confounders.\u003c/p\u003e\n\u003cp\u003eConflicting results in studies may stem from significant heterogeneity between non-IABP and IABP groups, with surgeons favorably selecting higher pre-operative risk patients for IABP insertion, introducing selection bias [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e]. Robust randomized control trials or propensity-score matching studies can mitigate this bias. Lack of consensus in the surgical community on the definition of high-risk patients further complicates the issue. While our study used EuroSCORE II\u0026thinsp;\u0026gt;\u0026thinsp;1.2%, others defined high-risk patients using various clinical variables [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]. Notably, the generalizability of IABP effects from studies like SHOCK II to bypass surgery patients is questioned [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]. Future research should focus on establishing a standardized criterion for defining high-risk patients benefiting from pre-operative IABP. Additionally, population and demographic factors, particularly in mixed Asian populations, remain understudied and may contribute to varied outcomes.\u003c/p\u003e\n\u003ch3\u003eLimitation\u003c/h3\u003e\n\u003cp\u003eThis study has limitations. Firstly, reliance on surgical registry data limits access to specific clinical details. Secondly, despite an 8-year duration and over 2900 patients, the small number of pre-operative IABP users and low event rate may yield statistically insignificant secondary outcomes. Thirdly, despite rigorous propensity-score matching, potential residual variables could introduce confounding effects. Lastly, as a single-center study, variations in IABP practices across centers were not considered. A large-scale multi-center randomized control trial is needed for comprehensive validation.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eUsing pre-operative IABP in high-risk patients (EuroSCORE II\u0026thinsp;\u0026gt;\u0026thinsp;1.2%) significantly reduces 30-day and 90-day mortality rates. Additionally, it correlates with a lower incidence of severe respiratory disorders, emphasizing the potential benefits for high-risk patients by enhancing short-term outcomes and respiratory well-being.\u003c/p\u003e"},{"header":"GLOSSARY OF ABBREVIATIONS ","content":"\u003cp\u003eBMI: Body mass index\u003c/p\u003e\n\u003cp\u003eCABG: Coronary artery bypass grafting\u003c/p\u003e\n\u003cp\u003eCHAID: Chi-square automatic interaction detection\u003c/p\u003e\n\u003cp\u003eDSRB: Domain specific review board\u003c/p\u003e\n\u003cp\u003eEuroSCORE: European system for cardiac operative risk evaluation\u003c/p\u003e\n\u003cp\u003eIABP: Intra-aortic balloon pump\u003c/p\u003e\n\u003cp\u003eNUH: National University Hospital\u003c/p\u003e\n\u003cp\u003eOR: Odds ratio\u003c/p\u003e\n\u003cp\u003ePCI: Percutaneous intervention\u003c/p\u003e\n\u003cp\u003ePSM: Propensity score matching\u003c/p\u003e\n\u003cp\u003eRRT: Renal replacement therapy\u003c/p\u003e\n\u003cp\u003eSHOCK: Should we emergently revascularize occluded coronaries for cardiogenic shock\u003c/p\u003e"},{"header":"DECLARATIONS","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003eConceptualization, F.S., H.L., G.C., D.W., Z.X., T.K., and G.K.; Methodology, D.W., Z.X., F.S., and H.L.; Software, D.W., Z.X., and F.S.; Validation, G.C., H.L., D.W., and F.S.; Formal analysis, D.W., Z.X., and F.S.; Data curation, D.W., Z.X., and F.S.; Writing\u0026mdash;original draft preparation, F.S., H.L., G.C., D.W., Z.X., T.K., and G.K.; Writing\u0026mdash;review and editing, F.S., H.L., G.C., D.W., Z.X., T.K., and G.K.; Visualization, D.W., Z.X., and F.S.; Resources, T.K., and G.C.; Supervision, F.S., and G.K.; Project administration, H.L., and F.S.; Funding acquisition, T.K., and G.K. All authors have read and agreed to the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research was not funded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u0026nbsp;\u003c/strong\u003eThe authors are thankful for the valuable contribution of Ms Cheryl Lim (NUH, Singapore).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e The author declares no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement:\u003c/strong\u003e Retrospective study, informed consent was waived.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u0026nbsp;\u003c/strong\u003eThe authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials. Raw data were generated at Cardiac Surgery Research Laboratory at the National University of Singapore. Derived data supporting the findings of this study are available from the corresponding author on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical registration number:\u0026nbsp;\u003c/strong\u003eDSRB:2016/01070\u003c/p\u003e"},{"header":"REFERENCES","content":"\u003col\u003e\n\u003cli\u003eBenjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Cheng, S., Chiuve, S. E., Cushman, M., Delling, F. N., Deo, R., de Ferranti, S. D., Ferguson, J. F., Fornage, M., Gillespie, C., Isasi, C. R., Jim\u0026eacute;nez, M. C., Jordan, L. C., Judd, S. E., Lackland, D., Lichtman, J. H., \u0026hellip; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee (2018). \u003cem\u003eHeart Disease and Stroke Statistics-2018 Update\u003c/em\u003e: A Report From the American Heart Association. 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European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 38(5), 585\u0026ndash;591. https://doi.org/10.1016/j.ejcts.2010.03.017\u003c/li\u003e\n\u003cli\u003eKunt, A. G., Kurtcephe, M., Hidiroglu, M., Cetin, L., Kucuker, A., Bakuy, V., Akar, A. R., \u0026amp; Sener, E. (2013). Comparison of original EuroSCORE, EuroSCORE II and STS risk models in a Turkish cardiac surgical cohort. \u003cem\u003eInteractive cardiovascular and thoracic surgery\u003c/em\u003e, 16(5), 625\u0026ndash;629. https://doi.org/10.1093/icvts/ivt022\u003c/li\u003e\n\u003cli\u003eNashef, S. A., Roques, F., Sharples, L. D., Nilsson, J., Smith, C., Goldstone, A. R., \u0026amp; Lockowandt, U. (2012). EuroSCORE II. \u003cem\u003eEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e(4), 734\u0026ndash;745. https://doi.org/10.1093/ejcts/ezs043\u003c/li\u003e\n\u003cli\u003eJamaati, H., Najafi, A., Kahe, F., Karimi, Z., Ahmadi, Z., Bolursaz, M., Masjedi, M., Velayati, A., \u0026amp; Hashemian, S. M. (2015). Assessment of the EuroSCORE risk scoring system for patients undergoing coronary artery bypass graft surgery in a group of Iranian patients. \u003cem\u003eIndian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine\u003c/em\u003e, 19(10), 576\u0026ndash;579. https://doi.org/10.4103/0972-5229.167033\u003c/li\u003e\n\u003cli\u003eKar, P., Geeta, K., Gopinath, R., \u0026amp; Durga, P. (2017). Mortality prediction in Indian cardiac surgery patients: Validation of European System for Cardiac Operative Risk Evaluation II. \u003cem\u003eIndian journal of anaesthesia\u003c/em\u003e, \u003cem\u003e61\u003c/em\u003e(2), 157\u0026ndash;162. https://doi.org/10.4103/ija.IJA_522_16\u003c/li\u003e\n\u003cli\u003eR-studio, integrated programming language for statistical computing and graphics, Developed by Posit, PBC. Available online from: https://posit.co/products/open-source/rstudio/ [Accessed on January 03, 2024]\u003c/li\u003e\n\u003cli\u003eThiele, H., Zeymer, U., Neumann, F. J., Ferenc, M., Olbrich, H. G., Hausleiter, J., de Waha, A., Richardt, G., Hennersdorf, M., Empen, K., Fuernau, G., Desch, S., Eitel, I., Hambrecht, R., Lauer, B., B\u0026ouml;hm, M., Ebelt, H., Schneider, S., Werdan, K., Schuler, G., \u0026hellip; Intraaortic Balloon Pump in cardiogenic shock II (IABP-SHOCK II) trial investigators (2013). Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. \u003cem\u003eLancet (London, England)\u003c/em\u003e, \u003cem\u003e382\u003c/em\u003e(9905), 1638\u0026ndash;1645. https://doi.org/10.1016/S0140-6736(13)61783-3\u003c/li\u003e\n\u003cli\u003eYoshimura, S., Kiguchi, T., Irisawa, T., Yamada, T., Yoshiya, K., Park, C., Nishimura, T., Ishibe, T., Kobata, H., Kishimoto, M., Kim, S. H., Ito, Y., Sogabe, T., Morooka, T., Sakamoto, H., Suzuki, K., Onoe, A., Matsuyama, T., Matsui, S., Nishioka, N., \u0026hellip; Iwami, T. (2023). 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F., Blankenberg, S., Dauw, J., Dindane, Z., Eckner, D., Eitel, I., Graf, T., Horn, P., Jozwiak-Nozdrzykowska, J., Kirchhof, P., Kluge, S., Linke, A., Landmesser, U., Luedike, P., L\u0026uuml;sebrink, E., \u0026hellip; Schrage, B. (2023). Association between left ventricular ejection fraction, mortality and use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock. \u003cem\u003eClinical research in cardiology : official journal of the German Cardiac Society\u003c/em\u003e, 10.1007/s00392-023-02332-y. Advance online publication. https://doi.org/10.1007/s00392-023-02332-y\u003c/li\u003e\n\u003cli\u003eLi, M., Hu, L., \u0026amp; Li, L. (2023). Research progress of intra-aortic balloon counterpulsation in the treatment of acute myocardial infarction with cardiogenic shock: A review. \u003cem\u003eMedicine\u003c/em\u003e, \u003cem\u003e102\u003c/em\u003e(49), e36500. https://doi.org/10.1097/MD.0000000000036500\u003c/li\u003e\n\u003cli\u003ePilarczyk, K., Boening, A., Jakob, H., Langebartels, G., Markewitz, A., Haake, N., Heringlake, M., \u0026amp; Trummer, G. (2016). Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials\u0026dagger;. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 49(1), 5\u0026ndash;17. https://doi.org/10.1093/ejcts/ezv258\u003c/li\u003e\n\u003cli\u003eEscutia-Cuevas H. H. (2021). Use of intra-aortic balloon pump during coronary artery bypass graft surgery. Current questions and few answers. \u003cem\u003eJournal of cardiac surgery\u003c/em\u003e, \u003cem\u003e36\u003c/em\u003e(4), 1466\u0026ndash;1467. https://doi.org/10.1111/jocs.15436\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"coronary artery bypass grafting, intra-aortic balloon pump, propensity score matching, in-hospital complications, open heart surgery","lastPublishedDoi":"10.21203/rs.3.rs-3960669/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3960669/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eThe aim of this study was to determine if pre-operative intra-aortic balloon pump (IABP) insertion improves the surgical outcomes of coronary artery bypass grafting (CABG).\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003ePatients with EuroSCORE II\u0026thinsp;\u0026gt;\u0026thinsp;1.2% who underwent CABG from 2009 to 2016 were included in the study. Patients who utilized intra-operative or post-operative IABP were excluded. The analysis included a total of 2907 patients, with 377 patients undergoing pre-operative IABP insertion and 1198 patients receiving no IABP support. Following propensity score matching, 250 patients from each group were eligible for further analysis.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003e30-day mortality events occurred in 9 (3.6%) non-IABP users and in 12 (4.8%) IABP users (OR: 1.33 95%CI: 0.52\u0026ndash;3.58). Kaplan-Meier survival curve analysis showed no significant differences between the two groups in mortality up to one year after the operation (p\u0026thinsp;=\u0026thinsp;0.72). On multivariate analysis, IABP usage among the PSM patients was associated with lower 30-day mortality (OR: 0.28, 95%CI: 0.07\u0026ndash;0.92, P-value\u0026thinsp;=\u0026thinsp;0.043), 90-day mortality (OR: 0.26, 95%CI: 0.08\u0026ndash;0.78, P-value\u0026thinsp;=\u0026thinsp;0.022) and reduced risk of developing severe respiratory disorders (OR: 0.10, 95%CI:0.01\u0026ndash;0.50, P-value\u0026thinsp;=\u0026thinsp;0.011).\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003ePre-operative IABP use in high-risk patients reduces 30- and 90-day mortality rates, along with a notable decrease in rates of severe respiratory disorders.\u003c/p\u003e","manuscriptTitle":"Pre-operative intra-aortic balloon pump insertion in coronary artery bypass grafting patients reduces in-hospital morbidity ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-21 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