Circulation, Vol 90, 2899-2904, Copyright © 1994 by American Heart Association
AW Hamer, M Takayama, KA Abraham, AH Roche, AR Kerr, BF Williams, MC Ramage and HD White
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.
ARTICLES
End-systolic volume and long-term survival after coronary artery bypass graft surgery in patients with impaired left ventricular function
Cardiology Department, Green Lane Hospital, Auckland, New Zealand.
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