CABG for Ischemic Cardiomyopathy

162 patients with severe left ventricular dysfunction (Ejection Fraction<35%) who underwent CABG from 2009 to 2017 were enrolled for this study. We evaluated the short term and mid term outcomes from this retrospective study.Mean age of the study population was 58.67±9.70 years. Operative mortality was 11.62%. 30 day/in house composite outcome of stroke and perioperative myocardial infarction were 5.8%... The percentage of survival for 1 year was 86.6 %, and 5 year survival was 79.9%. 5 year event-free survival was 49.3%. The mean ejection fraction improved from 30.7 + 4.08 % (Range 18-35) to 39.9 + 8.3 % (Range 24-60). Lack of improvement of left ventricular function was a strong predictor of late mortality (HR 21.41; CI 4.33-105.95). Even though there was a trend towards better early outcome in off-pump CABG, the 5 year survival rates were similar in off-pump and on-pump group(73.4 % and 78.9 % respectively; p value 0.356).
We showed that CABG in ischemic cardiomyopathy was associated with high early composite outcomes. However, the 5 year survival rates were good. Lack of improvement of left ventricular function was a strong predictor of late mortality.

本研究纳入2009年至2017年间接受冠状动脉旁路移植术（Coronary Artery Bypass Grafting, CABG）的162例重度左心室功能不全（射血分数<35%，Ejection Fraction）患者。本项回顾性研究评估了该队列的短期与中期临床结局。研究队列的平均年龄为58.67±9.70岁。手术死亡率为11.62%。术后30天内及院内卒中与围术期心肌梗死的复合结局发生率为5.8%……患者1年生存率为86.6%，5年生存率为79.9%，5年无事件生存率为49.3%。平均射血分数从基线的30.7±4.08%（范围18%~35%）提升至39.9±8.3%（范围24%~60%）。左心室功能未改善是晚期死亡率的强预测因子（风险比（Hazard Ratio, HR）=21.41；95%置信区间（Confidence Interval, CI）：4.33~105.95）。尽管非体外循环（off-pump）CABG组存在早期临床结局更优的趋势，但非体外循环与体外循环（on-pump）CABG组的5年生存率相近（分别为73.4%与78.9%；p=0.356）。
本研究结果显示，缺血性心肌病患者接受CABG治疗的早期复合结局发生率较高，但5年中期生存率表现良好。左心室功能未改善仍是晚期死亡率的强预测因子。