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Predicting survival after coronary revascularization for ischemic cardiomyopathy.

Publication ,  Journal Article
Langenburg, SE; Buchanan, SA; Blackbourne, LH; Scheri, RP; Sinclair, KN; Martinez, J; Spotnitz, WD; Tribble, CG; Kron, IL
Published in: Ann Thorac Surg
November 1995

BACKGROUND: The success of coronary revascularization for ischemic cardiomyopathy (left ventricular ejection fraction of 0.25 or less) has been unpredictable. We and others have demonstrated that the hospital operative mortality rate for these operations has been surprisingly low, particularly if evidence of ischemia is present. We subsequently liberalized our selection criteria based on our hypothesis that coronary artery bypass grafting is safe in this subset of patients regardless of the status of their distal coronary vasculature. METHODS: To examine this hypothesis, we studied retrospectively our patients undergoing coronary artery bypass grafting from 1983 to 1993. Ninety-six patients with ejection fractions of 0.25 or lower underwent this operation, with 88 hospital survivors (mortality 8%). All of the patients had clinical symptoms of heart failure. The male to female ratio was 4.6:1. The average age was 63.1 +/- 0.9 years (mean +/- standard error of the mean). Patients were excluded if they had valvular heart disease other than mild to moderate mitral regurgitation, required resection of a ventricular aneurysm, or required an emergency operation for acute coronary occlusion. Possible predictors of death were examined retrospectively. The catheterization films were reviewed retrospectively by a cardiovascular surgeon who was blinded to patient outcome and was never involved in the clinical management of any of the patients. Vessel quality was described as good, fair, or poor. RESULTS: Increased age and poor vessel quality were the only significant predictors of poor outcome. Sex, presence or absence of angina, preoperative angina, preoperative ejection fraction, preoperative arrhythmia disorder, aortic cross-clamp time, and the number of bypass grafts had no significant effect on outcome in the perioperative period. CONCLUSION: These results demonstrate that poor vessel quality and older age are predictors of poor outcome in patients with low ejection fractions undergoing myocardial revascularization. We conclude that poor distal coronary vasculature is a contraindication to coronary artery bypass grafting in patients with an ejection fraction of 0.25 or less, even if angina is present.

Duke Scholars

Published In

Ann Thorac Surg

DOI

ISSN

0003-4975

Publication Date

November 1995

Volume

60

Issue

5

Start / End Page

1193 / 1196

Location

Netherlands

Related Subject Headings

  • Survival Analysis
  • Stroke Volume
  • Single-Blind Method
  • Retrospective Studies
  • Respiratory System
  • Radiography
  • Prognosis
  • Predictive Value of Tests
  • Myocardial Ischemia
  • Middle Aged
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Langenburg, S. E., Buchanan, S. A., Blackbourne, L. H., Scheri, R. P., Sinclair, K. N., Martinez, J., … Kron, I. L. (1995). Predicting survival after coronary revascularization for ischemic cardiomyopathy. Ann Thorac Surg, 60(5), 1193–1196. https://doi.org/10.1016/0003-4975(95)00755-A
Langenburg, S. E., S. A. Buchanan, L. H. Blackbourne, R. P. Scheri, K. N. Sinclair, J. Martinez, W. D. Spotnitz, C. G. Tribble, and I. L. Kron. “Predicting survival after coronary revascularization for ischemic cardiomyopathy.Ann Thorac Surg 60, no. 5 (November 1995): 1193–96. https://doi.org/10.1016/0003-4975(95)00755-A.
Langenburg SE, Buchanan SA, Blackbourne LH, Scheri RP, Sinclair KN, Martinez J, et al. Predicting survival after coronary revascularization for ischemic cardiomyopathy. Ann Thorac Surg. 1995 Nov;60(5):1193–6.
Langenburg, S. E., et al. “Predicting survival after coronary revascularization for ischemic cardiomyopathy.Ann Thorac Surg, vol. 60, no. 5, Nov. 1995, pp. 1193–96. Pubmed, doi:10.1016/0003-4975(95)00755-A.
Langenburg SE, Buchanan SA, Blackbourne LH, Scheri RP, Sinclair KN, Martinez J, Spotnitz WD, Tribble CG, Kron IL. Predicting survival after coronary revascularization for ischemic cardiomyopathy. Ann Thorac Surg. 1995 Nov;60(5):1193–1196.
Journal cover image

Published In

Ann Thorac Surg

DOI

ISSN

0003-4975

Publication Date

November 1995

Volume

60

Issue

5

Start / End Page

1193 / 1196

Location

Netherlands

Related Subject Headings

  • Survival Analysis
  • Stroke Volume
  • Single-Blind Method
  • Retrospective Studies
  • Respiratory System
  • Radiography
  • Prognosis
  • Predictive Value of Tests
  • Myocardial Ischemia
  • Middle Aged