Ventricular Dysfunction in Patients with Acute Coronary Syndrome Undergoing Coronary Surgical Revascularization: Prognostic Impact on Long-Term Outcomes

Abstract

BackgroundPatients with non-ST elevation acute coronary syndrome complicated by left ventricular dysfunction (LVEF) are a poor prognosis group. The aim of our study was to assess the short and long term LEVF prognostic value in a cohort of NSTE-ACS patients undergoing surgical revascularization.MethodsWe performed elective and isolated CABG on a cohort of 206 consecutive patients with LVEF≤0.40 complicating acute coronary syndrome. The case cohort was compared with a cohort of controls (LVEF>0.40) randomly selected (2:1) among patients who underwent the procedure during this period.ResultsThe Kaplan-Meier 5-year estimated survival rates for patients in the low and normal LVEF groups were 70.8% (95% confidence interval CI: 64.2–77.4) and 81.7% (95%CI: 77.8–85.6), respectively. A low LVEF was associated with both a higher all-cause (HR [95%CI] = 1.84[1.18–2.86]) and a higher cardiovascular mortality (HR = 2.07 [1.27–3.38]) during the first 12 months of follow-up. After adjustment for potential confounders, a low LVEF remained associated with a higher cardiovascular mortality only (1.87[1.03–3.38]) during the first 12 months of follow-up. After 12 months of follow-up, a low LVEF was no more associated with all-cause, nor cardiovascular mortality.ConclusionPatients with low LVEF might require more intensive care than patients with normal LVEF during the year after the surgical procedure, but once the first postoperative year over, the initial low LVEF was no more associated with long term mortality.

Postoperative Neutrophil to Lymphocyte Ratio as an Overall Mortality Midterm Prognostic Factor following OPCAB Procedures

“…Decreased LVEF levels below 50% were found to be a mortality predictor. Postoperative deterioration of the left ventricle ejection fraction represents a myocardial perioperative injury significantly related to long-term survival, as postulated in previous studies [ 30 , 31 ].…”

The Strategy of Management Patients with non-ST Elevation Acute Coronary Syndrome

“…Из многообразия ангиографических и клинических ситуаций проистекает разнообразие способов реваскуляризации миокарда. Возможны одномоментные, поэтапные и избирательные (не на всех пораженных артериях) ЧКВ, операции КШ; кроме того, применяются гибридные методы (ЧКВ+КШ) [38,[47][48][49].…”