[Results of coronary surgery in mildly symptomatic patients with left ventricular dysfunction, multivessel disease and stenotic single residual patent vessel].
Abstract | BACKGROUND: METHODS: We selected retrospectively patients who underwent coronary angiography from 1986 trough 1993 and met the following criteria: presence of three-vessel coronary artery disease, occlusion of two and significant luminal narrowing (> or = 50%) of the third major epicardial artery, left ventricular dysfunction (ejection fraction < or = 40%), no angina or presence of mild angina, absence of inducible ischemia on exercise test and, when performed, of redistribution in the vascular territory of the patent vessel. RESULTS: Thirty-one consecutive patients underwent isolated surgical revascularization treatment, while thirty medically treated patients with matched clinical characteristics were selected. Age (61 +/- 10 vs 62 +/- 9), gender (M/F 27/3 vs 24/7), NYHA class I-II (53 vs 62%) or NYHA III-IV (47 vs 38%), incidence of previous infarction (87 vs 94%), number of reversible defects in the vascular territory of the patient vessel on stress scintigraphy (0.6 vs 0.5), patent vessel (right coronary artery 7 vs 10; left circumflex 14 vs 12; left anterior descending 9 vs 9) and left ventricular ejection fraction (28 +/- 8 vs 31 +/- 7), were similar in the two groups (medical vs surgical). Surgically treated patients exhibited a lower proportion of overall cardiac deaths (7/31, 23% vs 19/30, 63%; p < 0.001), and more prolonged survival (67 +/- 9.3 vs 34 +/- 2.5 months; p = 0.04, Mantel and Cox test) than medically treated patients, respectively. The incidence of perioperative myocardial infarction was 10% (3/31). Causes of cardiac death were myocardial ischemia (9/19; 47%), sudden death (5/19; 26%) and heart failure (5/19; 26%) in medical patients, while were surgery (3 cases) and surgery related infection (1 case) (total 4/7; 57%), myocardial ischemia (1/7; 14%), sudden death (1/7; 14%) and heart failure (1/7; 14%) in surgical patients. Cox proportional hazard regression analysis with survival as the dependent variable, identified treatment, surgical or medical, as the best predictor of cardiac events (chi square improvement 9.36, p = 0.002). The next most powerful predictors were NYHA class and ACE-inhibitors treatment (chi square improvement 4.47 and 2.79, respectively). CONCLUSIONS:
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Authors | J Dalle Mule, B Zingone, G Bilardo, B Sponga, P Pellegrini, B Branchini, C Burelli, D Zanuttini, F Martinelli, R Perelli |
Journal | Giornale italiano di cardiologia
(G Ital Cardiol)
Vol. 25
Issue 5
Pg. 561-74
(May 1995)
ISSN: 0046-5968 [Print] Italy |
Vernacular Title | Risultati della chirurgia coronarica nei pazienti paucisintomatici con disfunzione ventricolare sinistra, malattia multivasale e unico vaso residuo pervio stenotico. |
PMID | 7642061
(Publication Type: Comparative Study, English Abstract, Journal Article)
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Topics |
- Aged
- Chi-Square Distribution
- Coronary Angiography
- Coronary Artery Bypass
- Coronary Disease
(drug therapy, mortality, surgery)
- Electrocardiography
- Exercise Test
- Female
- Humans
- Male
- Middle Aged
- Proportional Hazards Models
- Retrospective Studies
- Survival Rate
- Time Factors
- Ventricular Dysfunction, Left
(complications)
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