0454: Prognosis impact of ventricular dysfunction in patients with acute coronary syndrome undergoing surgical revascularization

Abstract

Patients with non-ST elevation acute coronary syndrome complicated by left ventricular dysfunction are a poor prognosis. The aims of our study were to describe the use of surgical revascularization in these high risk patients and to assess the impact of left ventricular dysfunction on long term outcomes. Between 1996 and 2008, we performed elective, isolated, primary CABG in 206 consecutive patients with LVEF≤0.40 complicating acute coronary syndrome. The case group was compared with a group of controls randomly selected (2:1) among the patients who underwent the procedure during this period. The analysis of in-hospital course showed a significantly greater all-cause mortality (14.1% vs 7.3%, p<0.01) and cardiovascular mortality (12.7% vs 6.1% p<0.005) in the low LVEF group. Early postoperative morbidity including myocardial infarction (2.9% vs 3.4% p=ns), stroke (2.9% vs 1.5%, p=ns), digestive ischemia (1% vs 2.2%, p=ns) and mediastinitis (2.4% vs 1.9%, p=ns) was similar in two groups whereas acute renal failure (22.1% vs 14.9%, p=0.03) was significantly higher in low LVEF group. Differences in outcomes remained significant after adjusting all variables, low LVEF<40% appeared as an independent predictive factor of all-cause mortality (HR= 3.2 (95% confidence interval 1.8 to 5.7, p <0.001). Surgical revascularization in patients with left ventricular dysfunction complicating acute coronary syndrome is associated with a very high risk of subsequent adverse outcomes and continuing efforts to improve care for these high risk patients are particularly important in terms of diagnosis, revascularization strategy and secondary prevention