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Published on: March 27, 2018
Survival after myocardial revascularization for ischemic cardiomyopathy: a prospective ten-year follow-up study
Pallav J Shah1, David L Hare, Jai S Raman
1Department of Cardiac Surgery, Austin Hospital, Melbourne, Victoria, Australia.
Insights
Myocardial revascularization for ischemic cardiomyopathy offers initial symptom relief and preserves left ventricular function. However, long-term survival remains a significant concern, with high mortality rates observed over 10 years.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Outcomes Research
Background:
- Ischemic cardiomyopathy significantly impairs left ventricular function.
- Myocardial revascularization is a potential treatment strategy for such patients.
- Long-term outcomes and survival predictors require thorough investigation.
Purpose of the Study:
- To prospectively evaluate all-cause mortality.
- To identify predictors of survival.
- To assess late functional results after myocardial revascularization in ischemic cardiomyopathy over a decade.
Main Methods:
- Prospective study of 57 patients with coronary artery disease and ejection fraction <35%.
- Stress thallium imaging used to identify reversible ischemia in 37 patients.
- Exclusion of patients with recent unstable angina or myocardial infarction.
Main Results:
- Operative mortality was 1.7%. Left ventricular ejection fraction showed no significant change post-surgery.
- 10-year survival was 23.9%; symptom-free survival was 20.3%.
- Heart failure was the leading cause of death (29%). Male sex predicted improved long-term survival.
Conclusions:
- Myocardial revascularization provides initial symptomatic relief and may preserve left ventricular function.
- Despite initial benefits, long-term mortality following revascularization for ischemic cardiomyopathy remains high.
- Further strategies are needed to improve long-term survival in this patient group.
Objective:
The aim was to prospectively analyze all-cause mortality, predictors of survival, and late functional results after myocardial revascularization for ischemic cardiomyopathy over a 10-year follow-up.
Methods:
We prospectively studied 57 patients with stable coronary artery disease and poor left ventricular ejection function (<35%), enrolled between 1989 and 1994. Stress thallium was analyzed in 37 patients to identify reversible ischemia. To avoid patients with a stunned myocardium, we excluded those with unstable angina or myocardial infarction within the previous 4 weeks. Mean age of the patients was 67 +/- 8 years, and 93% of patients were men. Mean left ventricular ejection fraction was 0.28 +/- 0.04, 50% were in Canadian Cardiovascular Society angina class III-IV, and 65% were in New York Heart Association functional class III-IV.
Results:
Operative mortality was 1.7% (1/57). The mean left ventricular ejection fraction (0.30) at 15 months postoperatively did not change from before operation (0.28, P =.09). There were 8 deaths at 1 year and 42 deaths over the course of the study, producing a survival of 82.5% at 1 year, 55.7% at 5 years, and 23.9% at 10 years (95% confidence interval: 14.6%-39.1%). Symptom-free survival was 77.2% at 1 year and 20.3% at 10 years. The leading cause of death was heart failure in 29% (12/42). Multivariate analysis showed that large reversible defects on stress thallium were associated with improved left ventricular ejection fraction at 1 year (P =.01) but only male sex was associated with improved long-term survival (P =.036).
Conclusions:
Myocardial revascularization for ischemic cardiomyopathy is associated with good functional relief from the symptoms of angina initially and, to a lesser extent, heart failure. Revascularization may have the advantage of preserving the remaining left ventricular function. However, the long-term mortality remains high.
