Long-term Survival after CABG in Patients with Abnormal LV Wall Motion after MI

Choi, Jong Bum; Lee, Mi Kyung; Choi, Soon Ho

Abstract

BACKGROUND: Wall motion abnormalities may be a significant predictor for long-term survival after coronary bypass surgery (CABG). The aim of this study is to see whether post-infarction wall motion abnormality of left ventricle affect on the long-term survival after CABG. MATERIAL AND METHOD: One-hundred and thirty-three patients (male/ female, 92/41) undergoing CABG more than 9 years ago were included in this study. Fifty-six patients (M/F, 42/14; mean age, 59.2+/-9.2 years) with LV wall motion abnormalities were compared to 77 patients (M/F, 50/27; mean age, 58.0+/-7.6 years) without the wall motion abnormalities. Most patients (112/133, 84.2%) had undergone on-pump CABG with the in-situ left internal thoracic artery and free grafts of saphenous vein, in which the proximal and distal anastomoses were done for the single aortic cross-clamping period. RESULT: Ejection fraction of left ventricle was lower in the group with LV wall motion abnormalities (mean ejection fraction, 48.7+/-13.2%) compared to the group without wall motion abnormalities (mean ejection fraction, 57.1+/-10.1%)(p=0.0001). Risk-unadjusted survivals after CABG in the group without wall motion abnormalities were 85.7+/-4.0%, 76.2+/-4.9%, and 57.2+/-10.3% at 5, 10, and 13 years, respectively, and in the group with wall motion abnormalities were 80.4+/-5.3%, 58.7+/-7.3%, and 51.9+/-7.9% at 5, 10, and 13 years, respectively (p=0.1). In univariate analysis, predictable factors of long-term survival in the patients with LV wall motion abnormalities were LV ejection fraction and post operative outpatient treatment. In multivariate analysis, predictable factor of long-term survival in the patients with the wall motion abnormalities was postoperative outpatient treatment, and that in those without the wall motion abnormalities was female.
CONCLUSION
Although there was no significant survival difference after CABG between the group with LV wall motion abnormalities and that without wall motion abnormalities, the survival in the group with wall motion abnormalities seems to be more decreased. For the patients with LV wall motion abnormalities after myocardial infarction, the post-CABG outpatient treatment is suggested to be an important factor for the long-term survival.