Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Risk Factors of Coronary Artery Bypass Grafting According to Ventricular Function

좌심실기능에 따른 관상동맥우회술의 위험인자

  • 이헌재 (포천중문의대 분당차병원 심장센터 흉부외과) ;
  • 현성렬 (포천중문의대 분당차병원 심장센터 흉부외과, 중앙 길병원 심장센터 흉부외과)
  • Published : 1997.09.01
Download PDF
⟨ Previous Next ⟩

Abstract

Patients with coronary artery disease and depressed ventricular function have better longterm benefits after coronary artery bypass grafting compared with medical therapy. But operative mortality remains high. This study was designed to identify the risk factors for coronary artery bypass grafting according to ventricular function. The records of 103 patients who underwent coronary artery bypass grafting from truly 1994 to June 1996 were analysed. The patients were divided into two groups based on preoperative ejection fraction: Low EF group(Ejection fraction < 40%, n=24) and Normal EF group(Ejection fraction $\geq$ 40%, n=79). The indication of operation was significantly different between the two groups (p=0.00003). Postinfarction angina was frequent in Low EF group but unstable angina was frequent in Normal EF group. The frequency of cardiomegaly(p=0.0012), serum creatinine abnormality(p=0.0473) and preoperative use of IABP(Intra Aortic Balloon Pump, p=0.0095) were higher in Low EP group. The left internal thoracic artery was used less frequently in Low EP group(p=0.00416). The operative mortality was 8.3% in Low EF group and 5.1% in Normal EF group, but without statistical difference(p=0.5492). In Normal EF group, age (p=0.041) was identified as a significant risk factor for operative mortality. In Low EF group, age(p=0.018), preopertive use of IABP(p=0.0036), hypercholesterolemia(p=0.0007), and emergency of operation(p=0.0037) were identified as significant risk factors. Postoperative morbidity was 50% in Low EF group and 33olo in Normal EP group, but without s atistical significance(p=0.1007). These results suggest that in patients with coronary artery disease and depressed ventricular function, more aggresive coronary artery bypass grafting is needed to improve the symptom and long-term benefit.

.저자들은 1994년 7월부터 1996년 6월까지 관상동맥우회 술을 시행한 환자 103명을 심실구축력 40%를 기준 으로 심실기능저하군 24명과 심실기능정상군 79명으로 분류하여 환자의 술전,수술변수 18개를 분석하였다. 분석결과 환자의 특성과 수술사망에 영향을 미치는 위험인자에 대해 다음과 같은 결과를 얻었다. 1. 술전 변수중 심비대(p=0.0012), 혈청 크레아티닌 이상(p=0.0166), IABP 실시(p=0.0096)는 기능저하군이 기능 정상군보다 유의하게 높은 빈도를 보였다 2. 수술변수중 기능저하군은 수술적응증에 있어서 심근경색후 협심증의 빈도가 많았고(p=0.00003), 내흉동맥 의 사용은 유의하게 적었다(p=0.00416). 3. 조기사망률은 기능저하군이 기능정상군보다 약간 높았으나 통계적으로 유의한 차이는 없었다(기능저하군 8.3%, 기능정상군 5.1%, p=0.5492). 4. 합병증발생률은 기능저하군 50%(12/24), 기능정상군 33%(79/25)로 두군간에 유의한 차이는 없었다(p=0.1007). 5. 심실기능정상군에서는 연령(고령)(p=0.041)이 수술후 조기사망에 유의한 위험인자로, 심실기능저하군에서 는 연령(p=0.018)외에도 술전 IAaP 실시(p=0.0036), 고콜레스테롤혈증(p=0.00 7), 응급수술(p=0.0036)이 유의 한 위험인자로 작용하였다. 이상의 결과를 통해 심실기능이 저하된 관상동맥질환 환자는 심실기능이 정상인 환자에 비해 많은 술후 조기사망의 위험인자를 갖고있으나.술후 조기사망률과 합병증 발생률은 두 군간에 유의한 차이를 보이지 않 음으로써 심실기능이 저하된 환자에 있어서도 증상의 개선과 장기생존률의 향상을 얻기 위하여 좀더 적극적인 관상동맥우회 술의 실시가 필요할 것으로 생각된다.

Keywords

References

  1. N Engl J Med v.311 Eleven-year survival in the Veterans Administration Randomized Trial of Coronary Bypass Surgery for Stable Angina Veterans Administrative Coronary Artery Bypass Surgery Cooperative Study Group
  2. N Engl J Med v.3 Comparision of medical and surgical treatment for unstable angina pectori-s:results of a Veterans Administration Cooperative Study Luchi RJ;Scott SM;Deupree RH(et al.)
  3. J Thorac Cardiovasc Surg v.62 Coronary artery bypass graft for congestive heart failure: a report of experience with 40 patients Spencer FC;Green GE;Tice DA;Wallsh E;Mills NL;Glassman E
  4. J Thorac Cardiovasc Surg v.103 Coronary artery bypass grafting in patients with poor ventricular function Christakis GT;Weisel RD;Fremes SE(et al.)
  5. Ann Thorac Surg v.48 Factors influencing long term(10~15 year)survival after a successful coronary artery bypass operation Johnson WD;Brenovitz JB;Kayser LL
  6. Circulation v.78 Surgical survival benefits for coronary disease patients with left ventricular dysfunction Bounous EP;Mark DB;Pollock BG(et al.)
  7. N Engl J Med v.318 Out of hospital arrest Wilber DJ;Garan H;Finkelstein D(et al.)
  8. Circulation no.Suppl.80 The changing pattern of coronary bypass surgery Christakis GT;Birnbaum PL;Weisel RD(et al.)
  9. J Thorac Cardiovasc Surg v.93 Increased risk of urgent revasculization Teoh KH;Christakis GT;Weisel RD(et al.)
  10. J Thorac Cardiovasc Surg v.112 Predictors of low cardiac output syndrome after coronary artery bypass Rao V;Ivanov J;Weisel RD(et al.)
  11. Ann Thorac Surg v.56 Coronary artery bypass in patients with severely depressed ventricular function Carmelo AM;William DW;Richard Smith(et al.)
  12. N Engl J Med v.312 CASS principal investigators and their associates. A randomized trial of coronary artery bypass surgery: surgery: survival of patients with low ejection fraction Passamani E;Davis KB;Gillespie MJ;Killip T
  13. Circulation v.68 Results of coronary artery surgery in patients with poor left ventricular function(CASS) Alderman EL;Fisher LD;Litwin P(et al.)
  14. J Thorac Cardiovasc Surg v.88 Primary myocardial revasculization : trends in surgical mortality Cosgrove DM;Loop FD;Lytle BW(et al.)
  15. Ann Thorac Surg v.25 Criteria for operability and reduction of surgical mortality in patients with severe left ventricular ischemia and dysfunction Jones EL;Craver JM;Kaplan JA(et al.)
  16. Circulation v.48 Changing patterns of coronary bypass surgery Christakis GT;Ivanov J;Weisel RD(et al.)
  17. J Thorac Cardiovasc Surg v.80 Multivariate discriminant analysis of the clinical and angiographic predictors of operative mortality from the Collaborative Study in Coronary Artery Surgery(CASS) Kennedy JW;Kaiser GC;Fisher I.D(et al.)