Pg. Supino et al., RISK STRATIFICATION IN THE ELDERLY PATIENT AFTER CORONARY-ARTERY BYPASS-GRAFTING - THE PROGNOSTIC VALUE OF RADIONUCLIDE CINEANGIOGRAPHY, Journal of nuclear cardiology, 1(2), 1994, pp. 159-170
Citations number
39
Categorie Soggetti
Cardiac & Cardiovascular System","Radiology,Nuclear Medicine & Medical Imaging
Background. Recent data have shown that assessment of left ventricular
function by radionuclide cineangiography (RNCA) predicts survival and
cardiac events among non-age-selected patients who have previously un
dergone coronary artery bypass grafting (CABG). However, the prognosti
c value of this noninvasive approach is not known for elderly patients
who now undergo CABG with progressively increasing frequency and who
survive longer because of operation. Such easily applied prognostic in
dexes may be useful to determine whether survival benefits are likely
to be maintained or additional therapy should be considered. Methods a
nd Results. To obtain information on factors related to long-term surv
ival and cardiac events among elderly patients after CABG and, specifi
cally, to determine the prognostic implications of left ventricular pe
rformance at rest and during exercise for predicting all causes of dea
th, major nonsurgical cardiac events (death or myocardial infarction),
and event-free or surgery-free survival, we evaluated the late postop
erative course of 41 patients, aged 65 years and older, who had underg
one RNCA 1 month or more (mean 2.3 +/- 2.4 years; range 0.1 to 9 years
) after CABG. Average follow-up among patients with event-free surviva
l was 8.8 years after index radionuclide assessment. During follow-up
13 patients died with no known intercurrent event, five patients had n
onfatal myocardial infarctions, and five underwent late (greater than
or equal to 3 months after RNCA) repeat CABG or percutaneous translumi
nal coronary angioplasty. Log-rank comparisons of Kaplan-Meier product
limit estimate curves identified only left ventricular ejection fract
ion at rest as significantly predictive of survival (p < 0.04). Patien
ts. with left ventricular ejection fraction at rest of less than 45% h
ad a 7.8% average annual mortality risk, which was more than three tim
es that of patients with normal resting function. Statistical trends a
lso were found between mortality rates and completeness of revasculari
zation (p < 0.06), major nonsurgical cardiac events and extent of anat
omic disease (p < 0.08), and event-free or surgery-free survival and o
ur index of completeness of revascularization (p = 0.08) and age at in
dex RNCA (p < 0.07). Conclusions. Assessment of left ventricular eject
ion fraction at rest is prognostically useful after CABG among elderly
patients. The efficacy and timing of this approach should be confirme
d in further investigations with larger and more varied patient subgro
ups.