Functional Status Indicators and Long‐Term Mortality Following Elective Coronary Artery Bypass Grafting: A Multicenter Cohort Study

Background Coronary artery bypass grafting is the most commonly performed major surgical procedure worldwide. The prognostic value of preoperative functional status measures, including self‐perceived health, the physical domain of the MacNew heart‐related quality of life score, and estimated maximum oxygen consumption for long‐term mortality remains unclear. Methods We included 1146 patients undergoing coronary artery bypass grafting across 7 hospitals in Israel. Three functional status indicators were assessed: self‐perceived health, MacNew physical domain score, and estimated maximum oxygen consumption. Associations with all‐cause mortality were examined using multivariable Cox regression. Results Participants had a mean age of 65.6 ± 10 years, and 260 (23%) were female. Over a median follow‐up of 15.4 years (interquartile range, 10), 687 (59.6%) patients died. Multivariable Cox regression identified all functional status indicators to associate with mortality. Impaired self‐perceived health was the strongest predictor of mortality (hazard ratio [HR], 1.43 [95% CI, 1.2–1.7], P <0.001), followed by low baseline maximum oxygen consumption (HR, 1.2 [95% CI, 1.0–1.5], P =0.05) and poor MacNew physical domain score (HR, 1.2 [95% CI, 1.0–1.4], P =0.02). Discrimination, according to Harrell's C statistic was highest for self‐perceived health (C‐index, 0.729 [95% CI, 0.7–0.8], P <0.001). Net reclassification improvement analysis confirmed that self‐perceived health provided the greatest incremental value, correctly reclassifying 30% of participants (95% CI, 0.2–0.5; P <0.001) for mortality. Conclusions Self‐perceived health demonstrated better prognostic value, exceeding the functional status measures examined. Self‐perceived health, a single question indicator, should be considered a key measure for risk stratification and prognosis following coronary artery bypass grafting. Registration URL: https://clinicaltrials.gov ; Unique identifier: NCT00356863.