高度に左心機能が低下した虚血性心疾患の長期予後の検討

概要

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The prognosis of 124 ischemic heart disease (IHD) patients, whose left ventricular ejection fraction (EF) was 30% or less, was investigated. Forty of the patients were underwent intervention (31 coronary artery bypass graftings, 9 percutaneous transluminal coronary angioplasty, group I) and 84 received medical therapy (group M). Total mortality was 39%, while those of group I and group M were 20% and 48%, respectively. Three-year cumulative survival rate was 70% overall, 80% in group I and 64% in group M. Regardless of the presence or abscence of prior myocardial infarction and the number of diseased coronary arteries, survival was greater in group I than in group M. In group M, the patients who died of cardiac causes had a larger end diastolic volume index than did survivors (142 ± 45 vs 124 ± 41 ml/m^2, p<0.05). Among cardiac events in group M, ventricular tachycardia occurred more often in patients with single vessel disease (SVD) than in those with three vessel disease (TVD), and angina pectoris and recurrent myocardial infarction were more common in TVD than SVD. The mortality was also higher in TVD than in SVD (52 vs 21%, p<0.05). Intervention should be recommended in IHD patients with severe ventricular dysfunction, and therapy to prevent left ventricular dilatation is important.
東京女子医科大学の論文
1996-11-25