doi: 10.1161/hc3801.096335
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2001;104:1489.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Prior Coronary Artery Bypass Surgery and Risk of Death Among Patients With Ischemic Left Ventricular Dysfunction
From the Cardiovascular Research Group (G.D.V., D.V.E.), University of Calgary, Calgary, Alberta, Canada; Georgetown University Medical Center and Veterans Affairs Medical Center (S.N.S.) and Division of Cardiology, Georgetown University Medical Center (D.M.), Washington, DC; and the Department of Biostatistics (B.J.S.), University of Alabama at Birmingham, Ala.
Correspondence to Derek V. Exner, MD, 3330 Hospital Dr NW, Room G208, Calgary, AB, Canada T2N 4N1. E-mail exner{at}ucalgary.ca
Background— Patients with ischemic LV dysfunction are at high risk of sudden death. However, no benefit from prophylactic defibrillator therapy was observed in a group of patients with LV dysfunction undergoing CABG (CABG Patch trial). Thus, the effect of CABG on future risk of sudden death in patients with LV dysfunction is of considerable interest.
Methods and Results— Mortality and modes of death in 5410 patients with ischemic LV dysfunction who were enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) trials were evaluated. Outcomes of patients with (n=1870, 35%) versus without (n=3540) history of prior CABG were compared, and stratification by baseline ejection fraction (EF) values (<0.25, 0.25 to 0.30, and >0.30) was performed. Prior CABG was associated with a 25% (95% CI, 15% to 36%) reduction in risk of death and a 46% (95% CI, 30% to 58%) reduction in risk of sudden death independent of EF and severity of heart failure symptoms. As baseline EF declined, absolute reduction in risk of sudden death with prior CABG increased (P<0.01). No alteration in risk of death from progressive heart failure was observed with prior CABG. When these results were applied to a group of patients with LV dysfunction who had not undergone prior surgery (Coronary Artery Surgery Study Registry) predicted annual rates of death (8.2%) and sudden death (2.4%) were similar to those observed in the CABG Patch trial (7.9% and 2.3%, respectively).
Conclusions— In patients with ischemic LV dysfunction, prior CABG is associated with a significant independent reduction in mortality. These results appear to account for the lack of benefit from defibrillator therapy in the CABG Patch trial.
Key Words: bypass • ventricles • mortality • death, sudden
This article has been cited by other articles:
 |
|
 |
|
  C. A. Herzog, J. W. Strief, A. J. Collins, and D. T. Gilbertson Cause-specific mortality of dialysis patients after coronary revascularization: why don't dialysis patients have better survival after coronary intervention? Nephrol. Dial. Transplant., August 1, 2008; 23(8): 2629 - 2633. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Nisam and G. Breithardt Lessons learned from neutral ICD trials Europace, June 1, 2006; 8(6): 393 - 397. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Goldenberg, A. J. Moss, S. McNitt, W. Zareba, W. J. Hall, M. L. Andrews, D. J. Wilber, H. U. Klein, and for the MADIT-II Investigators Time Dependence of Defibrillator Benefit After Coronary Revascularization in the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II J. Am. Coll. Cardiol., May 2, 2006; 47(9): 1811 - 1817. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. K. Chung and J. O. O'Neill Reply to the Editor J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 1211 - 1211. [Full Text] [PDF]
|
|
|
|
|
|
K. Nanthakumar, A. E. Epstein, G. N. Kay, V. J. Plumb, and D. S. Lee Prophylactic implantable cardioverter-defibrillator therapy in patients with left ventricular systolic dysfunction: A pooled analysis of 10 primary prevention trials J. Am. Coll. Cardiol., December 7, 2004; 44(11): 2166 - 2172. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Sawada, A. Bapat, D. Vaz, J. Weksler, N. Fineberg, A. Greene, I. Gradus-Pizlo, and H. Feigenbaum Incremental value of myocardial viability for prediction of Long-Term prognosis in surgically revascularized patients with left ventricular dysfunction J. Am. Coll. Cardiol., December 17, 2003; 42(12): 2099 - 2105. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Al-Ruzzeh, T. Athanasiou, S. George, B. E. Glenville, A. C. DeSouza, J. R. Pepper, and M. Amrani Is the use of cardiopulmonary bypass for multivessel coronary artery bypass surgery an independent predictor of operative mortality in patients with ischemic left ventricular dysfunction? Ann. Thorac. Surg., August 1, 2003; 76(2): 444 - 451. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. W. Lytle The role of coronary revascularization in the treatment of ischemic cardiomyopathy Ann. Thorac. Surg., June 1, 2003; 75(90060): S2 - 5. [Full Text] [PDF]
|
|
|
|
|
|
D. S. Lee, L. D. Green, P. P. Liu, P. Dorian, D. M. Newman, F. C. Grant, J. V. Tu, and D. A. Alter Effectiveness of implantable defibrillators for preventing arrhythmic events and death: A Meta-Analysis J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1573 - 1582. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Kleikamp, A. Maleszka, N. Reiss, B. Stuttgen, and R. Korfer Determinants of mid- and long-term results in patients after surgical revascularization for ischemic cardiomyopathy Ann. Thorac. Surg., May 1, 2003; 75(5): 1406 - 1412. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Callans Management of the Patient Who Has Been Resuscitated From Sudden Cardiac Death Circulation, June 11, 2002; 105(23): 2704 - 2707. [Full Text] [PDF]
|
|
|
|
 |
|
 M.C Deng, D.D Ascheim, N.M Edwards, and Y Naka End-stage heart failure: which options? Eur. Heart J. Suppl., April 1, 2002; 4(suppl_D): D122 - D130. [Abstract] [PDF]
|
|
|
|
|
|
W. S. Weintraub Revascularization Versus Implantable Cardioverter-Defibrillators to Prevent Sudden Death in Patients With Severe Left Ventricular Dysfunction Circulation, September 25, 2001; 104(13): 1457 - 1458. [Full Text] [PDF]
|
|