Yajima Shin, Yoshioka Daisuke, Fukushima Satsuki, Toda Koichi, Miyagawa Shigeru, Yoshikawa Yasushi, Hata Hiroki, Saito Shunsuke, Domae Keitaro, Sawa Yoshiki
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Gen Thorac Cardiovasc Surg. 2018 Aug;66(8):446-455. doi: 10.1007/s11748-018-0937-7. Epub 2018 May 14.
We aimed to elucidate the relationship between the magnitude of myocardial recovery after coronary artery bypass grafting (CABG) and the prognosis and to explore the predictors of myocardial non-recovery.
Eighty-one patients with a preoperative left ventricular ejection fraction (LVEF) ≤ 40% who underwent isolated CABG between 2002 and 2015 and had undergone echocardiographic follow-up (median follow-up, 3.1 years; interquartile range 1.2-6.0 years) were analyzed. The Recovery group comprised patients with LVEF improvement ≥ 10%, whereas the Non-recovery group comprised those with an LVEF improvement < 10%. Group differences in overall survival, freedom from major adverse cardiac events (MACEs), and readmission due to heart failure were evaluated. In addition, the risk factors for LVEF non-recovery were evaluated in a multivariate analysis.
A total of 39 patients (48%) were in the Recovery group, whereas 42 patients (52%) were in the Non-recovery group. Although the survival and freedom from MACE rates were comparable, the rate of freedom from heart failure requiring hospitalization at 1, 5, and 8 years of follow-up was significantly lower in the Non-recovery group than in the Recovery group (p = 0.012). A history of percutaneous coronary intervention (PCI) was an exclusive independent risk factor for post-CABG myocardial non-recovery (odds ratio, 16.0; 95% confidence interval, 3.44-125). Furthermore, the number of coronary stents was negatively correlated with LVEF recovery (r = - 0.460, p = 0.024).
Great consideration should be taken when performing CABG in patients with left ventricular dysfunction and a history of PCI, particularly in those with multiple coronary stents.
我们旨在阐明冠状动脉旁路移植术（CABG）后心肌恢复程度与预后之间的关系，并探索心肌无恢复的预测因素。
分析了2002年至2015年间接受单纯CABG且术前左心室射血分数（LVEF）≤40%并接受超声心动图随访（中位随访时间3.1年；四分位间距1.2 - 6.0年）的81例患者。恢复组包括LVEF改善≥10%的患者，而非恢复组包括LVEF改善<10%的患者。评估了两组在总生存、无重大不良心脏事件（MACE）以及因心力衰竭再次入院方面的差异。此外，在多因素分析中评估了LVEF无恢复的危险因素。
共有39例患者（48%）在恢复组，42例患者（52%）在非恢复组。尽管生存和无MACE率相当，但在随访1年、5年和8年时，非恢复组因心力衰竭需要住院的无事件发生率显著低于恢复组（p = 0.012）。经皮冠状动脉介入治疗（PCI）史是CABG后心肌无恢复的唯一独立危险因素（比值比，16.0；95%置信区间，3.44 - 125）。此外，冠状动脉支架数量与LVEF恢复呈负相关（r = - 0.460，p = 0.024）。
对于有左心室功能障碍和PCI史的患者，尤其是有多枚冠状动脉支架的患者，进行CABG时应格外慎重。
