Coronary artery bypass for heart failure in ischemic cardiomyopathy: 17-year follow-up.

BACKGROUND: Coronary artery bypass grafting (CABG) has been safely extended to ischemic cardiomyopathy and heart failure, but outcome beyond 5 years remains poorly defined.

METHODS: We retrospectively analyzed 45 consecutive angina-free patients with ischemic left ventricular dysfunction (ejection fraction < or = 0.35) and heart failure (New York Heart Association functional class III to IV) who were selected for CABG between 1988 and 1995. Positron emission tomography was used for preoperative identification of myocardial viability.

RESULTS: The 30-day mortality was 4.4%. At a median follow-up of 117 months (longest observation, 205 months), the probability of survival at 1, 5, 10, and 15 years after CABG was 93.3%, 84%, 65%, and 44%, respectively. At multivariable analysis, a left ventricular end-diastolic pressure (LVEDP) of 25 mm Hg or more predicted a threefold increase of the hazard of death (p = 0.02), whereas a LVEDP of 20 mm Hg or more correlated with the requirement of an intraaortic balloon pump perioperatively (p = 0.04). Other independent predictors of survival were age older than 70 years and peripheral vascular disease. Cardiac events accounted for 88% of late deaths, which were primarily related to sudden death or progressive heart failure. Most patients were in New York Heart Association functional class I to II at late follow-up.

CONCLUSIONS: CABG alone yields good long-term outcome in selected angina-free patients with ischemic systolic dysfunction and advanced heart failure. However, associated diastolic impairment, reflected by elevated LVEDP, predicts reduced long-term survival despite myocardial viability.