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Identification of patients with improved survival following coronary bypass surgery
Insights
Coronary bypass surgery may improve survival in patients with two- or three-vessel disease and abnormal left ventricular performance. Noninvasive systolic time intervals identified these patients, showing better outcomes with surgery versus medical treatment.
Area of Science:
- Cardiology
- Cardiac Surgery
- Noninvasive Cardiology
Background:
- Left ventricular (LV) performance is crucial for patient outcomes after myocardial infarction.
- Systolic time intervals (STIs) offer a noninvasive method to assess LV performance.
- Identifying patients who benefit most from revascularization is clinically important.
Purpose of the Study:
- To determine if noninvasively measured LV performance using STIs can identify patients with coronary artery disease (CAD) who benefit from coronary bypass surgery (CBS).
- To compare survival rates in patients with normal versus abnormal LV performance undergoing CBS versus medical management.
Main Methods:
- Prospective study comparing 71 patients undergoing CBS with 78 medically treated patients with two- or three-vessel disease.
- LV performance assessed preoperatively using systolic time intervals, specifically the preejection period/left ventricular ejection time (PEP/LVET) ratio.
- Survival analysis using life table and log-rank tests.
Main Results:
- No significant difference in 5-year survival between surgical and medical groups for patients with normal LV performance (96% vs. 93%).
- Significantly greater 5-year survival in the surgical group compared to the medical group for patients with abnormal LV performance (84% vs. 62%, p < 0.01).
- No significant differences in PEP/LVET, vessel disease severity, or other risk variables between medical and surgical groups among patients with abnormal LV function.
Conclusions:
- Coronary bypass surgery may improve survival in patients with two- or three-vessel disease and documented left ventricular dysfunction.
- Noninvasive assessment of LV performance via STIs can help stratify risk and guide treatment decisions in CAD patients.
- CBS offers a survival benefit for a subset of patients with CAD and impaired LV function.
Abstract:
This study was designed to determine whether left ventricular performance measured noninvasively from the systolic time intervals could identify patients in whom coronary bypass surgery may improve survival. 71 patients with two- or three-vessel disease undergoing coronary bypass surgery were compared with 78 matched medically treated patients. All patients had recuperated from myocardial infarction by a mean of 17.6 months when systolic time intervals were performed. Surgical and medical patients were classified preoperatively into those with normal and those with abnormal left ventricular performance by preejection period/left ventricular ejection time (PEP/LVET less than or equal to 0.42 and greater than 0.42, respectively). Survival was analyzed by life table and log-rank test. Cumulative 5-year survival in patients with normal left ventricular performance was not statistically different in surgical and medical groups (96 vs. 93%, respectively). In contrast, cumulative survival in patients with abnormal left ventricular performance was significantly greater in the surgical group when compared to the medical group (84 vs. 62, p less than 0.01). Among the patients with abnormal left ventricular function, the mean PEP/LVET and the average vessel disease were not different in the medical and surgical groups. Multivariate analysis of 17 other clinical and laboratory risk variables were not different between these two groups. It is concluded that coronary bypass surgery my improve survival in patients with two- or three-vessel disease and left ventricular dysfunction.