High mortality associated with precluded coronary artery bypass surgery caused by severe distal coronary artery
Antônio Sérgio Cordeiro da Rocha1, Nella Paula Rodrigues Dassa, Felipe José Monassa Pittella
1Department of Coronary Artery Disease and Cardiac Surgery of Adults, Instituto Nacional de Cardiologia Laranjeiras, Ministério da Saúde, Rio de Janeiro, Brazil. ascrbr@centroin.com.br
Insights
Patients ineligible for coronary artery bypass grafting (CABG) due to extensive distal coronary artery disease (ENDCAD) face high mortality. Left ventricular dysfunction (LVD) significantly increases this risk, highlighting the need for alternative management strategies.
Area of Science:
- Cardiology
- Vascular Surgery
- Clinical Medicine
Background:
- Coronary artery disease (CAD) management often involves coronary artery bypass grafting (CABG) for improved patient prognosis, particularly with left ventricular dysfunction (LVD).
- Limited data exists on the clinical outcomes for patients with extensive and severe atherosclerotic involvement of distal coronary arteries (ENDCAD) who are not candidates for CABG.
- This study focuses on patients with multivessel (MV) or left main (LM) CAD where CABG was precluded due to ENDCAD.
Purpose of the Study:
- To evaluate the clinical course and outcomes of patients with multivessel or left main CAD who were not eligible for CABG due to ENDCAD.
- To identify risk factors associated with mortality and adverse cardiac events in this specific patient cohort.
Main Methods:
- A cohort of 51 patients with clinical indication for CABG but deemed ineligible due to ENDCAD were followed for at least 12 months or until death.
- Data collected included demographics, medical history (acute myocardial infarction, diabetes mellitus, systemic arterial hypertension), LVD status, and CAD severity (3-vessel CAD, LM CAD).
- Outcomes assessed included cardiac death, nonfatal acute myocardial infarction (AMI), and congestive heart failure.
Main Results:
- The study population (61+/-9 years) had high prevalence of diabetes mellitus (54.9%), LVD (51%), and 3-vessel CAD (60.8%).
- During follow-up, 39.2% experienced cardiac deaths, 37.2% had AMI, and 5.8% developed congestive heart failure.
- Diabetes mellitus, LVD, 3-vessel CAD, and LM CAD were significantly associated with increased mortality risk. Patients with 2-vessel CAD had no deaths but a higher rate of nonfatal AMI.
Conclusions:
- Patients with ENDCAD precluding CABG exhibit high mortality rates.
- Left ventricular dysfunction (LVD) is a critical factor associated with increased mortality in this population.
- Diabetes mellitus (especially insulin-dependent), left main CAD, and 3-vessel CAD are independent predictors of elevated risk.
Background:
Patients with extensive coronary artery disease (CAD) have better prognosis when treated with coronary artery bypass grafting surgery (CABG), especially when left ventricular dysfunction (LVD) is present. However, there are scanty data about the clinical course of patients not referred to CABG because of extensive and severe atherosclerotic involvement of distal coronary arteries (ENDCAD). The aim of this study was to evaluate patients with multivessel (MV) or left main CAD (LM) who had CABG precluded because of ENDCAD.
Methods And Results:
Between August 1999 and July 2001, 51 patients who had clinical indication but were not eligible for CABG because of ENDCAD were followed for at least 12 months or until death. There were 32 men and 19 women (age 61+/-9 years). Previous acute myocardial infarction (AMI) was present in 31 (60.8%), diabetes mellitus (DM) in 28 (54.9%), systemic arterial hypertension in 37 (72.5%), LVD (left ventricular ejection fraction <40%) in 26 (51%), 3 vessel CAD in 31 (60.8%), and LM in 4 (7.8%). During follow-up there were 20 cardiac (39.2%) deaths, 19 (37.2%) AMI, and 3 (5.8%) patients developed congestive heart failure. There were 2 (3.9%) noncardiac deaths. Patients with DM (60.7% versus 13%; P=0.001; odds ratio [OR], 10.30; 95% confidence interval [CI], 2.46 to 43.09), LVD (76.9% versus 0%; P<0.0001; OR, 4.33; 95% CI, 2.14 to 8.74), 3-vessel CAD (51.6% versus 20%; P=0.039; OR, 4.26; 95% CI, 1.16 to 15.69), and LM (100% versus 34%; P=0.019; OR, 1.25; 95% CI, 1.004 to 1.556) were more likely to die. There was no deaths in patients with 2-vessel CAD but they had more nonfatal AMI (43.8% versus 14.3%; OR, 4.667; 95% CI, 1.188 to 18.332).
Conclusions:
Patients in whom CABG could not be performed because of ENDCAD had high mortality, especially in the presence of LVD. DM (particularly insulin-dependent), LM CAD, and 3-vessel CAD were independent markers of increased risk.
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