Shah Pallav J, Hare David L, Raman Jai S, Gordon Ian, Chan Robert K, Horowitz John D, Rosalion Alex, Buxton Brian F
Department of Cardiac Surgery, Austin Hospital, Melbourne, Victoria, Australia.
J Thorac Cardiovasc Surg. 2003 Nov;126(5):1320-7. doi: 10.1016/s0022-5223(03)00809-2.
The aim was to prospectively analyze all-cause mortality, predictors of survival, and late functional results after myocardial revascularization for ischemic cardiomyopathy over a 10-year follow-up.
We prospectively studied 57 patients with stable coronary artery disease and poor left ventricular ejection function (<35%), enrolled between 1989 and 1994. Stress thallium was analyzed in 37 patients to identify reversible ischemia. To avoid patients with a stunned myocardium, we excluded those with unstable angina or myocardial infarction within the previous 4 weeks. Mean age of the patients was 67 +/- 8 years, and 93% of patients were men. Mean left ventricular ejection fraction was 0.28 +/- 0.04, 50% were in Canadian Cardiovascular Society angina class III-IV, and 65% were in New York Heart Association functional class III-IV.
Operative mortality was 1.7% (1/57). The mean left ventricular ejection fraction (0.30) at 15 months postoperatively did not change from before operation (0.28, P =.09). There were 8 deaths at 1 year and 42 deaths over the course of the study, producing a survival of 82.5% at 1 year, 55.7% at 5 years, and 23.9% at 10 years (95% confidence interval: 14.6%-39.1%). Symptom-free survival was 77.2% at 1 year and 20.3% at 10 years. The leading cause of death was heart failure in 29% (12/42). Multivariate analysis showed that large reversible defects on stress thallium were associated with improved left ventricular ejection fraction at 1 year (P =.01) but only male sex was associated with improved long-term survival (P =.036).
Myocardial revascularization for ischemic cardiomyopathy is associated with good functional relief from the symptoms of angina initially and, to a lesser extent, heart failure. Revascularization may have the advantage of preserving the remaining left ventricular function. However, the long-term mortality remains high.
旨在对缺血性心肌病心肌血运重建术后10年随访期间的全因死亡率、生存预测因素及晚期功能结果进行前瞻性分析。
我们前瞻性研究了1989年至1994年间纳入的57例稳定型冠状动脉疾病且左心室射血功能较差（<35%）的患者。对37例患者进行了负荷铊扫描分析以确定可逆性缺血。为避免纳入心肌顿抑患者，我们排除了既往4周内有不稳定型心绞痛或心肌梗死的患者。患者的平均年龄为67±8岁，93%为男性。平均左心室射血分数为0.28±0.04，50%的患者处于加拿大心血管学会心绞痛分级III-IV级，65%的患者处于纽约心脏协会功能分级III-IV级。
手术死亡率为1.7%（1/57）。术后15个月时的平均左心室射血分数（0.30）与术前（0.28）相比无变化（P = 0.09）。1年时有8例死亡，研究期间共有42例死亡，1年生存率为82.5%，5年生存率为55.7%，1年生存率为23.9%（95%置信区间：14.6%-39.1%）。无症状生存率1年时为77.2%，10年时为20.3%。主要死亡原因是心力衰竭，占29%（12/42）。多变量分析显示，负荷铊扫描上的大的可逆性缺损与1年时左心室射血分数改善相关（P = 0.0），但只有男性性别与长期生存改善相关（P = 0.036）。
缺血性心肌病的心肌血运重建最初可使心绞痛症状得到良好的功能缓解，在较小程度上也可缓解心力衰竭。血运重建可能具有保留剩余左心室功能的优势。然而，长期死亡率仍然很高。
