Predictors of long-term outcome in patients with left ventricular dysfunction following coronary artery bypass grafting.
BACKGROUND
Prognostic significance of clinical and non-invasive risk markers in patients after surgical revascularisation remains unclear, especially in post-infarction patients with left ventricular (LV) dysfunction.


OBJECTIVE
The single-centre, prospective study was designed to assess survival and the predictive power of several clinical and non- -invasive risk markers of all-cause (ACM) and cardiovascular mortality (CVM) in post-CABG patients with LV dysfunction.


METHODS
A cohort of 61 patients (age 59+/-9 years, 49 males, LVEF 33+/-6%) 6-12 months after CABG was prospectively followed for a median of 46 months. Demographics, clinical data, medication, LVEF, QRS>120 ms or late potentials (LP) presence, QT dispersion ł80 ms, premature ventricular contractions (PVC) ł10/h, non-sustained ventricular tachycardia (nsVT), and SDNN Ł70 ms in ambulatory ECG were analysed. The ACM and CVM were evaluated. The prognostic value of analysing parameters was determined.


RESULTS
Fourteen patients died, 10 of them due to cardiovascular causes. Univariate Cox analysis showed that incomplete revascularisation, history of angina, heart failure, low LVEF, use of nitrates, digitalis or diuretics, and presence of LP or prolongation of QRS complex were predictors of poor outcome. Combination of angina and low LVEF was the best model in a multivariable Cox analysies for the prediction of both types of death.


CONCLUSIONS
The present study showed that in post-CABG patients with LV dysfunction, angina class and low LVEF are the main predictors of ACM and CVM. Combination of LVEF <30% with the presence of QRS >120 ms or LP may also be helpful in the identification of high-risk subjects. Other common non-invasive risk markers, particularly arrhythmic and autonomic, seem to lose some of their predictive power in patients after CABG and receiving beta-blocking agents.
Rybicka-Musialik
Anna
A
1st Department of Cardiology, Medical University of Silesia, Katowice, Poland. rybickaanna@op.pl
Szydło
Krzysztof
K
Wita
Krystian
K
Filipecki
Artur
A
Orszulak
Witold
W
Tabor
Zbigniew
Z
Wnuk-Wojnar
Anna M
AM
Trusz-Gluza
Maria
M
Krejca
Michał
M
Bochenek
Andrzej
A
D000787:Angina Pectoris / Q000453:epidemiology; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality