END-SYSTOLIC VOLUME AND LONG-TERM SURVIVAL AFTER CORONARY-ARTERY BYPASS GRAFT-SURGERY IN PATIENTS WITH IMPAIRED LEFT-VENTRICULAR FUNCTION

Background Left ventricular function is the main predictor of long-term survival in patients with coronary artery disease. In patients with impaired left ventricular function after myocardial infarction, end-systolic volume is a better predictor than the global ejection fraction. We analyzed long-term follow-up of patients with impaired left ventricular function undergoing coronary artery bypass graft surgery to evaluate preoperative predictors of survival. Methods and Results Consecutive patients with ejection fractions less than or equal to 40% (n=193) who had undergone surgical revascularization were followed to assess the predictive value of preoperative baseline characteristics and catheterization findings for long-term survival. Patients were followed for 133+/-30.7 months. At the time of surgery, patient age was 56+/-7.9 years and 169 patients (87.6%) had a history of previous myocardial infarction. Thirty-one patients (16%) were female. The ejection fraction was 32+/-7%, and the end-systolic volume was 147.4+/-52.6 mL. One hundred sixty-four patients (84.9%) had three-vessel disease, and 44 (22.8%) had a left main stenosis with >50% diameter loss. Follow-up was complete in 99%. Fourteen patients died (7.3%) within the first 30 days after surgery. Twelve-month actuarial survival was 86%, 4-year survival was 80%, and 10-year survival was 40%. Predictors of poor long-term survival on multivariate analysis were end-systolic volume index (chi(2)=14.02, P=.002), number of previous myocardial infarctions (chi(2)-6.47, P=.001), preoperative stenosis score (chi(2)=4.97, P=.02), and age at the time of surgery (chi(2)=4.45, P=.03). Conclusions End-systolic volume index is the major predictor of survival after coronary artery bypass graft surgery in patients with impaired left ventricular function. Strategies to prevent ventricular dilatation, such as angiotensin-converting enzyme inhibitors, may improve the long-term outcome in these patients.