Prediction of outcome after revascularization in patients with poor left ventricular function.
BACKGROUND
In patients with poor left ventricular function, the determinants of outcome after revascularization are unknown.


METHODS
We studied prospectively 57 patients with stable coronary artery disease and poor left ventricular function (left ventricular ejection fraction, 0.28 +/- 0.04) who underwent coronary artery bypass grafting. Clinical variables were assessed as predictors of outcome in all patients, and preoperative stress thallium-201 scintigraphic data were analysed in 37 patients.


RESULTS
The operative mortality was 1.7%. At 12 months after operation, 46 of the 49 survivors were angina-free and 35 had fewer heart failure symptoms, but postoperative left ventricular ejection fraction (0.30 +/- 0.09) did not change significantly. Eighteen survivors had left ventricular ejection fraction improved by 0.05 or more (0.30 +/- 0.03 preoperatively, 0.40 +/- 0.05 postoperatively; p = 0.0001). The adjusted odds ratio of large reversible thallium-201 defects in predicting such outcome was 15 (95% confidence interval, 1.6 to 140), whereas other clinical variables had no predictive value. The transplantation-free 5-year survival was 73%.


CONCLUSIONS
In patients with poor left ventricular function, surgical revascularization can be performed safely, with good symptomatic relief and long-term survival. One-year survival and improvement in left ventricular function is better in patients with large reversible defects on preoperative stress thallium-201 scintigraphy.
Chan
R K
RK
Department of Cardiac Surgery, Austin and Repatriation Medical Center, Melbourne, Australia.
Raman
J
J
Lee
K J
KJ
Rosalion
A
A
Hicks
R J
RJ
Pornvilawan
S
S
Sia
B S
BS
Horowitz
J D
JD
Tonkin
A M
AM
Buxton
B F
BF
D000368:Aged; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015635:Radionuclide Ventriculography; D013794:Thallium Radioisotopes; D017211:Treatment Failure; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging
D013794:Thallium Radioisotopes