OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Entities:
Keywords:
Coronary artery bypass grafting; History of percutaneous coronary intervention; Ischemia cardiomyopathy; Multiple coronary stents; Myocardial recovery
Authors: Vittoria Rizzello; Don Poldermans; Elena Biagini; Arend F L Schinkel; Abdou Elhendy; Antonio Maria Leone; Filippo Crea; Alexander Maat; Jos R T C Roelandt; Jeroen J Bax Journal: Am J Cardiol Date: 2005-08-01 Impact factor: 2.778
Authors: V Rizzello; D Poldermans; E Biagini; A F L Schinkel; E Boersma; A Boccanelli; T Marwick; J R T C Roelandt; J J Bax Journal: Heart Date: 2009-05-13 Impact factor: 5.994
Authors: Eric J Velazquez; Kerry L Lee; Robert H Jones; Hussein R Al-Khalidi; James A Hill; Julio A Panza; Robert E Michler; Robert O Bonow; Torsten Doenst; Mark C Petrie; Jae K Oh; Lilin She; Vanessa L Moore; Patrice Desvigne-Nickens; George Sopko; Jean L Rouleau Journal: N Engl J Med Date: 2016-04-03 Impact factor: 91.245