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Title: Survival after myocardial revascularization for ischemic cardiomyopathy: a prospective ten-year follow-up study.
Austin Authors: Shah, Pallav J;Hare, David L ;Raman, Jai S ;Gordon, Ian R;Chan, Robert K ;Horowitz, John D;Rosalion, Alexander;Buxton, Brian F 
Affiliation: Department of Cardiac Surgery, Austin Hospital, Melbourne, Victoria, Australia
Issue Date: 1-Nov-2003
Publication information: The Journal of Thoracic and Cardiovascular Surgery; 126(5): 1320-7
Abstract: The aim was to prospectively analyze all-cause mortality, predictors of survival, and late functional results after myocardial revascularization for ischemic cardiomyopathy over a 10-year follow-up.We prospectively studied 57 patients with stable coronary artery disease and poor left ventricular ejection function (<35%), enrolled between 1989 and 1994. Stress thallium was analyzed in 37 patients to identify reversible ischemia. To avoid patients with a stunned myocardium, we excluded those with unstable angina or myocardial infarction within the previous 4 weeks. Mean age of the patients was 67 +/- 8 years, and 93% of patients were men. Mean left ventricular ejection fraction was 0.28 +/- 0.04, 50% were in Canadian Cardiovascular Society angina class III-IV, and 65% were in New York Heart Association functional class III-IV.Operative mortality was 1.7% (1/57). The mean left ventricular ejection fraction (0.30) at 15 months postoperatively did not change from before operation (0.28, P =.09). There were 8 deaths at 1 year and 42 deaths over the course of the study, producing a survival of 82.5% at 1 year, 55.7% at 5 years, and 23.9% at 10 years (95% confidence interval: 14.6%-39.1%). Symptom-free survival was 77.2% at 1 year and 20.3% at 10 years. The leading cause of death was heart failure in 29% (12/42). Multivariate analysis showed that large reversible defects on stress thallium were associated with improved left ventricular ejection fraction at 1 year (P =.01) but only male sex was associated with improved long-term survival (P =.036).Myocardial revascularization for ischemic cardiomyopathy is associated with good functional relief from the symptoms of angina initially and, to a lesser extent, heart failure. Revascularization may have the advantage of preserving the remaining left ventricular function. However, the long-term mortality remains high.
DOI: 10.1016/s0022-5223(03)00809-2
ORCID: 0000-0001-9554-6556
Journal: The Journal of thoracic and cardiovascular surgery
PubMed URL: 14666002
Type: Journal Article
Subjects: Aged
Analysis of Variance
Coronary Artery Bypass.methods.mortality
Follow-Up Studies
Middle Aged
Myocardial Revascularization.methods.mortality
Predictive Value of Tests
Proportional Hazards Models
Prospective Studies
Risk Assessment
Sampling Studies
Severity of Illness Index
Survival Analysis
Time Factors
Treatment Outcome
Ventricular Dysfunction, Left.diagnosis
Appears in Collections:Journal articles

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