Survival and outcomes of coronary artery bypass grafting in patients with extremely low ejection fraction (≤20%): A systematic review and meta-analysis
In brief
CABG yields 74% five-year survival in patients with EF 20% or less
A meta-analysis of 29 studies (5,910 patients) found that coronary artery bypass surgery in individuals with an ejection fraction of 20% or lower carries a 9% peri-operative death rate and a 16% chance of low cardiac output, yet 74% of survivors are alive at five years. The data suggest that despite notable short-term risk, bypass can offer meaningful long-term survival for this high-risk group.
- Journal
- JTCVS open (Q1)
- Published
- 6 June 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Wenteng Hou, Iris Liu, Nader S Aboelnazar, Rashmi Nedadur, Thin Xuan Vo, A Dave Nagpal
- PMID
- 42604318
- DOI
- 10.1016/j.xjon.2026.101922
Why clinicians should know about it
- Picked for Epidemiology (top studies of the week, 23 August 2026).
- Picked for Cardiology and Cardiovascular Medicine (top studies of the week, 23 August 2026): CABG outcomes in EF ≤20% patients
Abstract
OBJECTIVES: To assess perioperative outcomes and long-term survival of coronary artery bypass in patients with ejection fraction (EF) 20% or less. METHODS: We performed a systematic search of MEDLINE, EMBASE, and CENTRAL via OVID for both randomized controlled trials and cohort studies involving patients with EF ≤20% undergoing coronary artery bypass grafting, including results from 1995 to December 2023. Random-effects prevalence meta-analysis was performed using the meta library in R. Outcome prevalence was logit-transformed and pooled using a generalized linear mixed-effects model. The presence of heterogeneity was assessed using the Cochran Q test with a significance of P < .10 following Cochrane Handbook recommendations and further quantified using I 2 statistic. RESULTS: A total of 29 studies involving 5910 patients were included in this analysis. The pooled prevalence of perioperative mortality was 9%. Postoperative myocardial infarction and stroke prevalence were 2% and 3%, respectively. Low cardiac output syndrome definition varied across studies, and its pooled prevalence was 16%, with postoperative mechanical circulatory support requirement at 9%, the pooled 5-year survival rate was 74%. CONCLUSIONS: Despite elevated short-term risk, patients with severely low LVEF (≤20%) may derive long-term survival benefit from coronary artery bypass grafting and therefore it should remain a consideration in advanced heart failure therapies.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.