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Title: Evolution of left ventricular ejection fraction in patients with multivessel coronary heart disease submitted to 3 therapeutic strategies: 10 years follow-up
Citation: EUROPEAN HEART JOURNAL, v.33, suppl.1, p.458-458, 2012
Abstract: Background: Coronary artery bypassgraft (CABG) and percutaneous coronary intervention (PCI) are assumed aseffective therapeutic options for the protection of the ischemic myocardium. However, it is not established if those procedures are mandatory for leftventricular ejection fraction (LVEF) preservation. In this setting, weevaluated the evolution of LVEF in patients with chronic multivessel coronary- heart disease, submitted to CABG, PCI or medical treatment (MT) alone, after afollow-up of ten years. Methods: Echocardiography wasperformed on patients participants of MASS II trial, previously to randomizationfor CABG, PCI or MT, and after 10 years. LVEF was measured by the biplanemethod (Simpson) preferably, but on obligatory basiswhen regional wall-motion abnormalities were present, or alternatively by the Teichholz method. Results: After afollow-up of 10,32 (±1.43)years, 350 patients had LVEF reassessed: 108 patientson MT, 111 on CABG and 131 on PCI group. Main baseline characteristics and theoccurrence of AMI were similar among the three groups. There was no difference of LVEF either at the beginning (0,61 + 0,07, 0,61 + 0,08 e 0,61 +0,09 respectively for PCI, CABG and MT, p=0,675) and the end of follow up (0,56+ 0,11, 0,55 + 0,11 e 0,55 + 0,12 respectively for PCI,CABG and MT, p=0,675). The impact ofother variables over LVEF evolution, such as gender, age, diabetes and arterial pattern, were also analyzed, and no relevance was demonstrated. However, the presence of previous AMI (OR 2.50, 95% CI 1.40- 4.45; p= 0.0007) and theoccurrence of AMI during follow up (OR 2.73, 95% IC 1.25-5.92; p=0,005) were associated with an increased risk of developing LVEF < 45%. Also, AMIduring follow-up was responsible for a greater reduction of LVEF (reductiondelta of 18,29 ± 21,22% and 6,63 ± 18,91%, respectively for patients with andwithout AMI, p=0.001). Conclusion: In this study, the evolution of ventricular function on patients of MT-group, with unprotected coronary heart disease, was similar to those withme-chanical revascularization, either by PCI or CABG. Besides, irrespective ofthe therapeutic strategy applied, the occurrence of AMI was responsible for agreater decrease of LVEF.
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Comunicações em Eventos - FM/MCP
Departamento de Cardio-Pneumologia - FM/MCP

Comunicações em Eventos - HC/InCor
Instituto do Coração - HC/InCor

Comunicações em Eventos - LIM/11
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação

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