MYOCARDIAL REVASCULARIZATION IN CAD PATIENTS WITH LEFTVENTRICULAR EJECTION FRACTION BELOW 35%

Yu.M. Saakyan, R.S. Polyakov, M.V. Puretsky, O.V. Sankov, S.A. Abugov, I.V. Zhbanov
Russian Scientific Center of Surgery, RAMS,
Moscow, Russia

The aim of the present study was to compare the short- arid long-term clinical results in CAD patients with an initial LV ejection fraction below 35% after coronary stenting and coronary artery bypass grafting (CABG).

Methods and results: the study accrued 94 CAD patients with an initial LV ejection fraction below 35%. As dependent on the revascularization techniques performed, the patients were distributed into two groups. The first group comprised patients after intracoronary stenting. The second group included patients who had undergone CABG. Both groups were comparable in terms of the basic clinical criteria. The short-term clinical success of intervention in CS and CABG groups accounted for 97.6% and 97.7% respectively (p>0.05). The hospital lethality was significantly higher in the CABG group than in the CS group and was quoted as 13.7% versus 2.3% (p<0.05). No significant differences in the clinical status were recorded among patients with the clinical success. In the long-term period, the three-year survival in the CS and CABG groups accounted for 73.2% and 79.1% respectively (p>0.05). The incidence of unfavourable clinical events (UCE) in the CABG group was recorded significantly less frequently than in the CS group and constituted 21.9% versus 39% (p<0.05). Complete "freedom" from angina and UCE in the CABG group was recorded significantly more often among CABG group patients versus the CS group: 79.1% versus 60.9% respectively (p<0.05).

Conclusion: As regards the immediate clinical efficacy both methods of revascularization are not statistically different. However, CABG is associated with a significantly higher hospital lethality. In turn, in the long-term period with the three-year survival in the study groups being statistically comparable), the incidence of UCE is recorded significantly most frequently in the CS group.

KEY WORDS: coronary angioplasty, coronary stenting, coronary artery bypass grafting, low left ventricular ejection fraction, prediction.

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