Key result
Low LVEF is linked to ~84% higher first-year mortality after NSTE-ACS surgical revascularization, fading thereafter.
Why the study?
Does low LVEF (≤0.40) compared to normal LVEF (>0.40) increase long-term mortality in patients with NSTE-ACS undergoing CABG?
Observational (n=618)
No
Does low LVEF (≤0.40) compared to normal LVEF (>0.40) increase long-term mortality in patients with NSTE-ACS undergoing CABG?
Effect estimate: HR 1.84 (95% CI 1.18-2.86)
In patients with NSTE-ACS undergoing CABG, low LVEF increases cardiovascular mortality only during the first postoperative year, after which long-term survival is comparable to those with normal LVEF.
Warrants heightened early post-CABG surveillance in low-LVEF NSTE-ACS; leaves open LVEF's prognostic role beyond 12 months.
BACKGROUND: Patients with non-ST elevation acute coronary syndrome complicated by left ventricular dysfunction (LVEF) are a poor prognosis group. The aim of our study was to assess the short and long term LEVF prognostic value in a cohort of NSTE-ACS patients undergoing surgical revascularization. METHODS: We performed elective and isolated CABG on a cohort of 206 consecutive patients with LVEF≤0.40 complicating acute coronary syndrome. The case cohort was compared with a cohort of controls (LVEF>0.40) randomly selected (2:1) among patients who underwent the procedure during this period. RESULTS: The Kaplan-Meier 5-year estimated survival rates for patients in the low and normal LVEF groups were 70.8% (95% confidence interval CI: 64.2-77.4) and 81.7% (95%CI: 77.8-85.6), respectively. A low LVEF was associated with both a higher all-cause (HR [95%CI] = 1.84[1.18-2.86]) and a higher cardiovascular mortality (HR = 2.07 [1.27-3.38]) during the first 12 months of follow-up. After adjustment for potential confounders, a low LVEF remained associated with a higher cardiovascular mortality only (1.87[1.03-3.38]) during the first 12 months of follow-up. After 12 months of follow-up, a low LVEF was no more associated with all-cause, nor cardiovascular mortality. CONCLUSION: Patients with low LVEF might require more intensive care than patients with normal LVEF during the year after the surgical procedure, but once the first postoperative year over, the initial low LVEF was no more associated with long term mortality.
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Popovic et al. (2016) conducted an observational in Non-ST-Segment Elevation Acute Coronary Syndrome (NSTE-ACS) (n=618). Low LVEF (≤0.40) vs. Normal LVEF (>0.40) was evaluated on All-cause mortality (< 12 months) (HR 1.84, 95% CI 1.18-2.86). In patients with NSTE-ACS undergoing surgical revascularization, low LVEF (≤0.40) was associated with higher all-cause mortality during the first 12 months (HR 1.84) compared to normal LVEF, but this association did not persist beyond one year.
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