Prognostic factors in patients with advanced multi-vessel coronary artery disease.
BACKGROUND
Multivessel coronary artery disease (CAD) not suitable for revascularisation remains a challenge for present cardiology. Due to high mortality and difficulties in pharmacological therapy patients with this particular disease constitute a group of great interest.


OBJECTIVE
To define the main unfavourable prognostic factors in patients with clinically stable multivessel CAD who do not qualify for percutaneous or surgical revascularisation.


METHODS
The analysed group consisted of 106 patients (79 men, 66+/-8 years) with multi-vessel CAD, confirmed in coronary angiography, who were primarily disqualified from interventional treatment. Thirty-eight (36%) of them had diabetes and 5 (5%) had a previous stroke. The left ventricular ejection fraction was 37+/-15%, and mean Gensini score - 72+/-34.


RESULTS
During 7.4+/-4 years of follow-up, 19 (18%) patients died. Predicting factors of mortality included older age (p=0.014), higher heart rate (p=0.02), diabetes (0.003), renal failure (p=0.0003), heart failure (p=0.013), past stroke (p=0.006) and lower left ventricular ejection fraction (p=0.0012). In multivariate logistic analysis the only significant parameter related to prognosis was decreased level of haemoglobin (p=0.007) and elevated leucocytosis (p=0.002). The ROC curves analysis showed that decreased Hgb (<12.3 g/dl) and increased leucocytosis (>11.3 t/mm3) were significantly associated with higher mortality (HR 6.3).


CONCLUSIONS
In patients with multi-vessel CAD not amendable revascularization the haemoglobin level and leucocytosis seem to be at least as important as well known risk factors. More intensive complex pharmacotherapy and innovative cell and gene therapeutic methods may improve the prognosis in this group of patients.
Krecki
Radosław
R
II Katedra i Klinika Kardiologii Uniwersytetu Medycznego, Wojewódzki Szpital Specjalistyczny im. W. Biegańskiego, ul. Kniaziewicza 1/5, 91-347 Łódź. rpmed1@wp.pl
Drozdz
Jarosław
J
Krzemińska-Pakuła
Maria
M
D000368:Aged; D000818:Animals; D000075202:Contraindications; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000378:metabolism / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007964:Leukocytosis / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009204:Myocardial Revascularization; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
D006454:Hemoglobins