Hamer A W, Takayama M, Abraham K A, Roche A H, Kerr A R, Williams B F, Ramage M C, White H D
Cardiology Department, Green Lane Hospital, Auckland, New Zealand.
Circulation. 1994 Dec;90(6):2899-904. doi: 10.1161/01.cir.90.6.2899.
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.
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).
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.
左心室功能是冠心病患者长期生存的主要预测指标。在心肌梗死后左心室功能受损的患者中，收缩末期容积比整体射血分数是更好的预测指标。我们分析了接受冠状动脉搭桥手术的左心室功能受损患者的长期随访情况，以评估术前生存预测指标。
连续纳入射血分数≤40%（n = 193）且接受手术血运重建的患者，随访以评估术前基线特征和导管检查结果对长期生存的预测价值。患者随访时间为133±30.7个月。手术时，患者年龄为56±7.9岁，169例患者（87.6%）有既往心肌梗死病史。31例患者（16%）为女性。射血分数为32±7%，收缩末期容积为147.4±52.6 mL。164例患者（84.9%）有三支血管病变，44例患者（22.8%）有左主干狭窄且直径损失>50%。99%的患者随访完整。14例患者（7.3%）在术后30天内死亡。12个月精算生存率为86%，4年生存率为80%，10年生存率为40%。多因素分析显示，长期生存不良的预测指标为收缩末期容积指数（χ2 = 14.02，P = .002）、既往心肌梗死次数（χ2 = 6.47，P = .001）、术前狭窄评分（χ2 = 4.97，P = .02）和手术时年龄（χ2 = 4.45，P = .03）。
收缩末期容积指数是左心室功能受损患者冠状动脉搭桥手术后生存的主要预测指标。预防心室扩张的策略，如血管紧张素转换酶抑制剂，可能改善这些患者的长期预后。
