End-systolic volume and long-term survival after coronary artery bypass graft surgery in patients with impaired left ventricular function
| Autor: | Barbara F. Williams, Alan R. Kerr, Harvey D. White, K A Abraham, M C Ramage, Andrew Hamer, M Takayama, A H Roche |
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| Rok vydání: | 1994 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Coronary artery disease Ventricular Dysfunction Left Physiology (medical) Internal medicine medicine Humans Derivation Myocardial infarction Coronary Artery Bypass Systole End-systolic volume Aged Ejection fraction business.industry Stroke Volume Impaired left ventricular function Middle Aged Prognosis medicine.disease Survival Analysis Surgery medicine.anatomical_structure Multivariate Analysis Cardiology Female Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | Circulation. 90:2899-2904 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/01.cir.90.6.2899 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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