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End-systolic volume and long-term survival after coronary artery bypass graft surgery in patients with impaired left
A W Hamer1, M Takayama, K A Abraham
1Cardiology Department, Green Lane Hospital, Auckland, New Zealand.
Insights
End-systolic volume index is the key predictor of survival in patients with reduced left ventricular function after coronary artery bypass graft surgery. This finding highlights potential strategies to improve long-term outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Outcomes
Background:
- Left ventricular function is crucial for long-term survival in coronary artery disease patients.
- End-systolic volume is a more potent predictor than ejection fraction in post-myocardial infarction patients with impaired left ventricular function.
- This study evaluated preoperative predictors of survival in patients with impaired left ventricular function undergoing coronary artery bypass graft surgery.
Purpose of the Study:
- To assess the predictive value of preoperative baseline characteristics and catheterization findings for long-term survival.
- To identify key factors influencing survival in patients with ejection fractions <= 40% undergoing surgical revascularization.
- To determine the major predictor of survival after coronary artery bypass graft surgery in this patient cohort.
Main Methods:
- Analysis of long-term follow-up data from 193 patients with ejection fractions <= 40% who underwent coronary artery bypass graft surgery.
- Evaluation of preoperative patient demographics, medical history, and cardiac catheterization findings.
- Multivariate analysis to identify predictors of long-term survival.
Main Results:
- The study followed 193 patients for an average of 133 months; 164 had three-vessel disease and 44 had left main stenosis.
- Long-term survival rates were 86% at 1 year, 80% at 4 years, and 40% at 10 years.
- Multivariate analysis identified end-systolic volume index, number of prior myocardial infarctions, preoperative stenosis score, and age as significant predictors of poor long-term survival.
Conclusions:
- End-systolic volume index is the primary predictor of survival following coronary artery bypass graft surgery in patients with impaired left ventricular function.
- Strategies aimed at preventing ventricular dilatation, such as utilizing angiotensin-converting enzyme inhibitors, may enhance long-term outcomes.
- Identifying and addressing preoperative predictors can guide treatment strategies to improve survival in high-risk cardiac patients.
Background:
Left ventricular function is the main predictor of long-term survival in patients with coronary artery disease. In patients with impaired left ventricular function after myocardial infarction, end-systolic volume is a better predictor than the global ejection fraction. We analyzed long-term follow-up of patients with impaired left ventricular function undergoing coronary artery bypass graft surgery to evaluate preoperative predictors of survival.
Methods And Results:
Consecutive patients with ejection fractions < or = 40% (n = 193) who had undergone surgical revascularization were followed to assess the predictive value of preoperative baseline characteristics and catheterization findings for long-term survival. Patients were followed for 133 +/- 30.7 months. At the time of surgery, patient age was 56 +/- 7.9 years and 169 patients (87.6%) had a history of previous myocardial infarction. Thirty-one patients (16%) were female. The ejection fraction was 32 +/- 7%, and the end-systolic volume was 147.4 +/- 52.6 mL. One hundred sixty-four patients (84.9%) had three-vessel disease, and 44 (22.8%) had a left main stenosis with > 50% diameter loss. Follow-up was complete in 99%. Fourteen patients died (7.3%) within the first 30 days after surgery. Twelve-month actuarial survival was 86%, 4-year survival was 80%, and 10-year survival was 40%. Predictors of poor long-term survival on multivariate analysis were end-systolic volume index (chi 2 = 14.02, P = .002), number of previous myocardial infarctions (chi 2 = 6.47, P = .001), preoperative stenosis score (chi 2 = 4.97, P = .02), and age at the time of surgery (chi 2 = 4.45, P = .03).
Conclusions:
End-systolic volume index is the major predictor of survival after coronary artery bypass graft surgery in patients with impaired left ventricular function. Strategies to prevent ventricular dilatation, such as angiotensin-converting enzyme inhibitors, may improve the long-term outcome in these patients.