IMPACT OF EARLY EXERCISE RADIONUCLIDE CINEANGIOGRAPHY ON LONG-TERM PROGNOSIS AFTER CABG

Background. The immediate benefits of coronary artery bypass grafting might be only transient. This prospective study examined the capabilit y of exercise radionuclide cineangiography done shortly after coronary artery bypass grafting to predict outcome and long-term prognosis. Me thods. Results of exercise radionuclide cineangiography at 5.5 +/- 0.7 months (range, 4 to 8 months) postoperatively were correlated with mo rtality, major surgical and nonsurgical cardiac events, and cardiac ev ent-free survival in 100 consecutive patients who underwent coronary a rtery bypass grafting. Stepwise logistic regression analysis was used to evaluate the incremental value of radionuclide cineangiography beyo nd the commonly used variables. Results. Left ventricular ejection fra ction at rest was normal (greater than or equal to 0.45) in 72 patient s and increased on exercise in 58. The exercise radionuclide variables that correlated with future cardiac events were change and fractional change in heart rate, ST segment changes, anginal pain and congestive heart symptoms during exercise, rest ejection fraction, and change an d fractional changes in ejection fraction. Predictors of event-free su rvival were exercise heart rate, rest ejection fraction, and change an d fractional change in ejection fraction during exercise. Logistic reg ression analysis revealed that change in ejection fraction was an inde pendent predictor of cardiac death and surgical interventions, whereas resting ejection fraction was a predictor of nonsurgical cardiac even ts. Conclusions. Postoperative exercise radionuclide cineangiography c arried out soon after coronary artery bypass grafting had definite ind ependent prognostic value and should be performed routinely to help de cide treatment protocol. (C) 1997 by The Society of Thoracic Surgeons.