Surgical revascularization in stable coronary artery disease with ventricular dysfunction: a single-center cohort

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Rakan I Nazer1, Abdulaziz M Alhothali1, Mansour S Alghamdi2

  • 1Department of Cardiac Science, King Fahad Cardiac Center, College of Medicine, King Saud University Riyadh, Kingdom of Saudi Arabia.

American Journal of Cardiovascular Disease
|July 29, 2021
PubMed

Insights

Coronary artery bypass grafting (CABG) outcomes were assessed in stable coronary artery disease (CAD) patients with left ventricular (LV) dysfunction. Despite higher pre-operative ischemia, LV dysfunction did not significantly impact long-term cardiac death risk after CABG.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Nuclear Cardiology

Background:

  • Stress-gated myocardial perfusion scintigraphy (MPS) is a prognostic tool for stable coronary artery disease (CAD).
  • Left ventricular (LV) dysfunction is a known predictor of adverse cardiac events.
  • The impact of LV dysfunction on outcomes after coronary artery bypass grafting (CABG) in patients undergoing MPS requires further clarification.

Purpose of the Study:

  • To evaluate the outcomes of CABG in stable CAD patients with and without LV dysfunction identified by stress-gated MPS.
  • To determine if pre-operative LV dysfunction influences long-term cardiac mortality after CABG.

Main Methods:

  • Retrospective analysis of 130 stable CAD patients who underwent CABG between 2012-2019 and had pre-operative stress-gated MPS.
  • Patients were stratified into a control group and an LV dysfunction group based on post-stress LV ejection fraction.
  • Outcomes including low cardiac output syndrome and long-term cardiac death were compared between groups.

Main Results:

  • Patients with LV dysfunction exhibited significantly higher summed stress and resting scores, indicating more extensive myocardial ischemia.
  • The LV dysfunction group had a higher risk of developing low cardiac output syndrome post-surgery (OR: 2.9).
  • Freedom from cardiac death at 4.7 years was not statistically different between groups (90.2% vs. 95.6%), and cardiac death was not influenced by LV dysfunction or extent of ischemic myocardium.

Conclusions:

  • Significant myocardial ischemia and LV dysfunction prior to CABG did not adversely affect long-term cardiac death risk.
  • Improved survival after CABG may be attributed to successful revascularization in patients with pre-existing ischemia and LV dysfunction.
  • Stress-gated MPS can help identify patients who may benefit from CABG despite LV dysfunction.
Abstract

Keywords:
Coronary revascularizationimagingprognosis

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