Improved outcome after coronary bypass surgery in patients with ischemic cardiomyopathy and residual myocardial viability.
Improved outcome after coronary bypass surgery in patients with ischemic cardiomyopathy and residual myocardial viability.
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DOI：
10.1161/01.cir.96.3.793
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发表时间：
1997-08
期刊：
影响因子：
37.8
通讯作者：
P. R. Pagley;G. Beller;D. Watson;L. Gimple;M. Ragosta
中科院分区：
文献类型：
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作者：
P. R. Pagley;G. Beller;D. Watson;L. Gimple;M. Ragosta
尽管冠状动脉疾病和广泛区域性心功能不全患者的残余心肌存活与冠状动脉搭桥术后心室功能改善相关，但存活与术后临床结局之间的关系尚不清楚。我们假设，与存活心肌较少的患者相比，心室功能差且存活心肌占优势的患者在旁路手术后的结局更好。方法和结果70例多支冠状动脉疾病和左心室射血分数0.67的患者（n=33）与存活率较低的患者（第2组;存活指数≤ 0.67; n=37）在年龄、合并症和冠状动脉疾病程度方面相似。第1组患者中有6例心源性死亡，无心脏移植，第2组患者中有15例心源性死亡和2例移植。Kaplan-Meier分析显示，第1组患者的无心源性死亡或移植的生存率明显更高（P= 0.018）。结论：静息201 Tl脑血管造影可能有助于术前风险分层，以识别更可能从手术血运重建中获益的患者。
BACKGROUND Although residual myocardial viability in patients with coronary artery disease and extensive regional asynergy is associated with improved ventricular function after coronary bypass surgery, the relationship between viability and clinical outcome after surgery is unclear. We hypothesized that patients with poor ventricular function and predominantly viable myocardium have a better outcome after bypass surgery compared with those with less viability. METHODS AND RESULTS Seventy patients with multivessel coronary artery disease and left ventricular ejection fractions 0.67; n=33) were similar to patients with less viability (group 2; viability index < or = 0.67; n=37) with respect to age, comorbidities, and extent of coronary artery disease. There were 6 cardiac deaths and no heart transplants in group 1 patients and 15 cardiac deaths and two transplants in group 2 patients. Survival free of cardiac death or transplantation was significantly better in group 1 patients on Kaplan-Meier analysis (P=.018). CONCLUSIONS We conclude that resting 201Tl scintigraphy may be useful in preoperative risk stratification for identification of patients more likely to benefit from surgical revascularization.