Multiple coronary stenting negatively affects myocardial recovery after coronary bypass grafting

Area of Science:

• Cardiology
• Cardiac Surgery
• Cardiovascular Research

Background:

• Left ventricular dysfunction (LVEF ≤ 40%) is a significant concern in patients undergoing coronary artery bypass grafting (CABG).
• Understanding myocardial recovery post-CABG is crucial for predicting patient outcomes and optimizing treatment strategies.

Purpose of the Study:

• To investigate the association between the extent of myocardial recovery after CABG and patient prognosis.
• To identify predictors of myocardial non-recovery in patients with reduced left ventricular ejection fraction.

Main Methods:

• Analysis of 81 patients with LVEF ≤ 40% who underwent isolated CABG and had echocardiographic follow-up (median 3.1 years).
• Patients were categorized into Recovery (LVEF improvement ≥ 10%) and Non-recovery (LVEF improvement < 10%) groups.
• Evaluation of overall survival, freedom from major adverse cardiac events (MACEs), and heart failure readmissions; multivariate analysis for non-recovery predictors.

Main Results:

• 48% of patients achieved significant LVEF recovery (Recovery group), while 52% did not (Non-recovery group).
• The Non-recovery group had significantly lower rates of freedom from heart failure hospitalizations at 1, 5, and 8 years.
• Prior percutaneous coronary intervention (PCI) was an independent predictor of myocardial non-recovery (OR 16.0), with more stents negatively correlating with LVEF recovery (r=-0.460).

Conclusions:

• Myocardial recovery magnitude after CABG is linked to prognosis, particularly concerning heart failure readmissions.
• A history of PCI, especially with multiple stents, is a significant risk factor for impaired myocardial recovery post-CABG.
• Careful consideration is warranted for CABG in patients with left ventricular dysfunction and prior PCI history.