This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Supino, P. G. Articles by Hochreiter, C. Search for Related Content PubMed PubMed Citation Articles by Supino, P. G. Articles by Hochreiter, C. Related Collections Exercise testing CV surgery: coronary artery disease

(Circulation. 1999;100:924-932.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Prognostication in 3-Vessel Coronary Artery Disease Based on Left Ventricular Ejection Fraction During Exercise

Influence of Coronary Artery Bypass Grafting

Phyllis G. Supino, EdD; Jeffrey S. Borer, MD; Edmund M. Herrold, MD, PhD; Clare Hochreiter, MD

From the Division of Cardiovascular Pathophysiology, The Joan and Sanford I. Weill Medical College of Cornell University, The New York Presbyterian Hospital–Weill Cornell Medical Center, New York, NY.

Background—Previous data indicate that left ventricular ejection fraction (LVEF) provides prognostic information among patients with coronary artery disease (CAD), but the value of such testing specifically for defining benefits of coronary artery bypass grafting (CABG) may relate to severity of exercise-inducible ischemia measured noninvasively before surgery.

Methods and Results—To determine the independent prognostic importance of preoperative ischemia severity for predicting outcomes of CABG among patients with extensive CAD, we monitored 167 stable patients with angiographically documented 3-vessel CAD (average follow-up of 9 years in event-free patients) who previously had undergone rest and exercise radionuclide cineangiography. Their course was correlated with data obtained during initial radionuclide testing, coronary arteriography, and clinical evaluation at study entry. Fifty-two patients received medical treatment only, and 115 underwent CABG (44 early [1 month after initial study]). Multivariate Cox model analysis indicated that change () in LVEF from rest to exercise during radionuclide study was the strongest independent predictor of major cardiac events (P=0.003) before surgery and also predicted magnitude of CABG benefit (P=0.04). Patients with LVEF -8% or less derived significant survival-prolonging and event-reducing benefit from CABG performed 1 month after initial testing (P<0.02 for cardiac death and P=0.008 for cardiac events], early CABG versus medical-treatment-only patients); similar benefits were absent among patients with LVEF more than -8%, and among those in whom CABG was deferred.

Conclusions—Assessment of ischemia severity based on LVEF response to exercise enables effective prognostication among patients with 3-vessel CAD and defines the likelihood of life-prolonging and event-reducing benefits from CABG.

Key Words: prognosis • ischemia • coronary disease • grafting