Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Int J Cardiol. 2013 Oct 15;168(6):5316-22. doi: 10.1016/j.ijcard.2013.08.009. Epub 2013 Aug 15.
In the surgical management of ischemic cardiomyopathy, factors associated with long-term prognosis after coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) dysfunction are poorly understood. This study aimed to determine predictors of clinical outcomes in patients with severe LV dysfunction undergoing CABG.
Out of 6084 patients who underwent CABG between 1997 and 2011, 476 patients (aged 62.6 ± 9.3 years, 100 females) were identified as having severe LV dysfunction (ejection fraction ≤ 35%), preoperatively. All-cause mortality and adverse cardiac events (myocardial infarction, repeat revascularization, stroke and hospitalization due to cardiovascular causes) were evaluated during a median follow-up period of 55.2 months (inter-quartile range: 26.4-94.8 months).
During the follow-up, 187 patients (39.3%) died and 126 cardiac events occurred in 104 patients (21.8%). Five-year survival and event-free survival rates were 72.1 ± 2.2% and 61.3 ± 2.4%, respectively. On Cox-regression analysis, old age (P < 0.001), recent MI (P < 0.001), history of coronary stenting (P = 0.023), decreased glomerular filtration rate (P < 0.001), and presence of mitral regurgitation (≥moderate) (P = 0.012) or LV wall thinning (P = 0.007) emerged as significant and independent predictors of death. After adjustment for important covariates affecting outcomes, none of the pump strategy (off-pump vs. on-pump), concomitant mitral surgery or surgical ventricular reconstruction (SVR) affected survival or event-free survival (P = 0.082 to >0.99).
Long-term survival following CABG in patients with severe LV dysfunction was affected by age, renal function, recent MI, prior coronary stenting, and presence of mitral regurgitation or LV wall thinning. Neither concomitant mitral surgery nor SVR, however, had significant influence on clinical outcomes.
在缺血性心肌病的外科治疗中，严重左心室（LV）功能障碍患者行冠状动脉旁路移植术（CABG）后长期预后的相关因素仍不清楚。本研究旨在确定严重 LV 功能障碍患者行 CABG 的临床结局的预测因素。
在 1997 年至 2011 年间接受 CABG 的 6084 例患者中，有 476 例（年龄 62.6±9.3 岁，女性 100 例）术前被诊断为严重 LV 功能障碍（射血分数≤35%）。在中位随访 55.2 个月（四分位距：26.4-94.8 个月）期间，评估全因死亡率和不良心脏事件（心肌梗死、再次血运重建、卒中和心血管原因住院）。
随访期间，187 例（39.3%）患者死亡，104 例（21.8%）患者发生 126 例心脏事件。5 年生存率和无事件生存率分别为 72.1±2.2%和 61.3±2.4%。Cox 回归分析显示，年龄较大（P<0.001）、近期心肌梗死（P<0.001）、冠状动脉支架史（P=0.023）、肾小球滤过率降低（P<0.001）、二尖瓣反流（≥中度）（P=0.012）或 LV 壁变薄（P=0.007）是死亡的显著独立预测因素。在调整影响结局的重要协变量后，泵策略（非体外循环与体外循环）、同期二尖瓣手术或心室重建术（SVR）对生存或无事件生存均无影响（P=0.082 至>0.99）。
严重 LV 功能障碍患者行 CABG 后的长期生存率受年龄、肾功能、近期心肌梗死、既往冠状动脉支架置入和二尖瓣反流或 LV 壁变薄的影响。然而，同期二尖瓣手术或 SVR 对临床结局无显著影响。
