title: End-systolic volume and long-term survival after coronary artery bypass graft surgery in patients with impaired left ventricular function.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cardiology Department, Green Lane Hospital, Auckland, New Zealand.
authors.forename: A W
authors.initials: AW
authors.lastname: Hamer
authors.forename: M
authors.initials: M
authors.lastname: Takayama
authors.forename: K A
authors.initials: KA
authors.lastname: Abraham
authors.forename: A H
authors.initials: AH
authors.lastname: Roche
authors.forename: A R
authors.initials: AR
authors.lastname: Kerr
authors.forename: B F
authors.initials: BF
authors.lastname: Williams
authors.forename: M C
authors.initials: MC
authors.lastname: Ramage
authors.forename: H D
authors.initials: HD
authors.lastname: White
mesh_terms: D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D013318:Stroke Volume; D016019:Survival Analysis; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*