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[Prognosis and predictive factors of mortality in patients with inoperable coronary disease]
L Chevalier1, M Koch, M Hajjar
1Hôpital cardiologique du Haut-Lévêque, Pessac.
Insights
Patients with coronary artery disease deemed inoperable due to poor circulation or heart function face a grim prognosis. Revascularization, even high-risk procedures, may improve outcomes for these high-risk cardiac patients.
Area of Science:
- Cardiology
- Vascular Medicine
Context:
- Focuses on patients with coronary artery disease (CAD) deemed inoperable.
- Examines a cohort from September 1979 to December 1986.
- Includes 105 inoperable patients (93 male, 12 female) with a mean age of 58.1 years.
Purpose:
- To evaluate the long-term prognosis of inoperable coronary artery disease patients.
- To identify predictive factors for major cardiac events and survival.
- To assess the potential benefit of secondary revascularization strategies.
Summary:
- Inoperable CAD patients (n=105) were followed for a mean of 69 months.
- Poor distal coronary circulation was the primary reason for inoperability (84.8%).
- Kaplan-Meier 10-year survival was 43%, with only 25% remaining event-free; coronary angiographic score was the sole significant predictor.
Impact:
- Highlights the poor long-term prognosis for inoperable CAD patients.
- Suggests that even high-risk, partial revascularization should be considered.
- Informs clinical decision-making for complex coronary artery disease management.
Abstract:
In the period between September 1979 and December 1986, 105 out of 2,178 consecutive patients with coronary artery disease (men 93, women 12; age : 58.1 +/- 10 years; previous myocardial infarction : 67%) were considered inoperable because of poor distal coronary circulation (84.8%), left ventricular dysfunction (3.8%) or both (11.4%). Fifty-four clinical, ergometric and angiographic parameters were examined at inclusion. The mean follow-up was 69 +/- 40.2 months (1 to 146 months). The Kaplan Meier 10 year survival rate was 43%. Only 25% of the population remained free of major cardiac events. Multivariate analysis showed that only the coronary angiographic score had a significant predictive value. The authors conclude that the long-term prognosis of these patients is poor. Some did undergo coronary bypass surgery secondarily, and their prognosis was good, suggesting that revascularisation, even if only partial and at high risk, should be considered.