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Long-Term Mortality and Morbility in
Multivessel Ischemic Cardiopathy

Sanchez-Rubio, Juan; Galache, José G.;
Chopo, José M.; Brun, David;
Molinero, Edmundo; Salazar, José;
Calvo, Isabel; Alonso, Carmen; Placer, Luis J.

Hospital Universitario Miguel Servet, Zaragoza, Spain

SUMMARY
Introduction and aims: Multivessel ischemic cardiopathy (MIC) patients present high morbimortality. We did five-year monitoring of clinical events and related factors.
Methods: Monitoring 70 patients MIC-diagnosed in 1995, >60% lesions in at least 2 vessels. Analysis of risk factors (RF), admission number and reason, revascularizations, coronariographies (CRP), EF, affected vessels, monitoring and mortality AMI. Statistical analysis: Mann-Whitney, Kolmogorov-Smirnov and t-Student. Data obtaining: clinical history and interview.
Results: A 57 months mean monitoring per patient (1-70). 78,5% male, 21,5% female. See Table 1 for results.

61% of patients required 1 CRP, 22% 2, 13% 3, and 4% 4 or more. 72,3% were revascularized and 27.7% non revascularized; 67% due to unfavourable anatomy, 15% high risk, and 18% other reasons. 50,7% had surgery (21,5% triple by-pass, 26,1% double, 3,1% single). 18% of all patients were admitted once, 34% two times, 23% three, and 25% four or more (average 3,15; 1-15). Mean admission period was 49 days (4-326). 67,5% suffered IMA during 5 years. 28% died: 18% for cardiac reasons, 4% for cardiovascular reasons and 6% for other reasons. Diabetics had less surgery (44% vs 76%, p<0.014), suffered more AMI (p<0.02) and suffered more admissions (p<0.003).
Conclusions: Most frequent RF in MIC patients are AMI, tobacco, hypertension and high cholesterol levels. Diabetes is linked to minor possibility of surgical revascularization, more admissions and higher AMI probability. UA is the main readmission cause. Survival after 5 years was 72%. Only 10% kept event-free after 5 years.

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INTRODUCTION
   The patients affected by multivessel ischemic cardiopathy - MIC- constitute a population subject to a high morbimortality requiring numerous hospital admissions.

AIMS
   First of all, to carry out a descriptive study of a population of patients affected by MIC registering all the clinical events that occurred during a period of five years. Secondly, we tried to identify the risk factors and clinical markers that are related to a high morbimortality.

METHODS
   We carried out a follow-up study in a sample of 70 patients who were diagnosed of MIC in 1995. Apart from that, as a second criterium they had to present 60% of major lesions in at least two main vessels or 40% of major lesions in case of left main coronary affection. After a monitoring period of 5 years we put together a list of risk factors (hypertension, diabetes mellitus -DM-, dislipemia -DL-, tobacco, angor history, previous AMI, left ventricular ejection fraction -LVEF-, coronary anatomy and all of the events that occurred during this period of time (admission motives, AMI, exitus, revascularization -surgical or percutaneous- and number of coronarygraphies) trying to establish a relationship between the two.

   We obtained data through the revision of the clinical history and interviews during the month of December 2000. We carried out the statistical analysis using the t-Student for quantitative variables and the Mann-Whitney and X2 non-parametric tests.

RESULTS
   The mean age of population was 68 years (range 40-83, standard deviation (ds) 10,2), with 78,5% male and 21,5% female. We monitored the patients for a mean period of 57 months (range 1-70, ds 21,2). As far as the risks factors are concerned, the results are shown in table 1. In the five years of study, 18% of patients were admitted at least once, two times 34%, three times 23% and four times or more 25% of the patients (an average of 3,15 admissions, range 1-15). The average length of admission period was 49 days (range 4-326). The motive of admission was unstable angina in 41% of the cases, AMI in 24%, cardiac failure 11%, stable angina 6% and 18% for other causes (arrhythmias, revascularization).

   61% of the patients required one coronariography, 22% two, 13% three coronariographies and 4% four or more coronariographies (range 1-5). In table 2 we can see the data obtained in the coronariographies (LEVF, affected territories and angioplasties).

    Table 3 shows the number of patients revascularized 72,3% vs 27,7% of non-revascularized patients (67% due to unfavourable anatomy, 15% due to high risks and 18% due to other causes). Among the patients who were subjected to surgical revascularization (50,7%) 21% received a triple bypass, 26,1% a double by-pass and 3,1% a single by-pass. The medical treatment that each group received is shown in table 4.

   During the five years of study, 67% of the patients suffered AMI (once 53,8%, two times 12,4% and three or more times 1,5%). The mortality rate in five years was 28%, of witch 64% was due to cardiac causes, 15% due to cardiovascular causes like cerebral stroke or aneurisms and 21% due to other reasons.

   Analyzing the different risk factors, diabetics were the group of highest morbility since they required more admissions than the others (p<0,02) and received surgical revascularization on fewer occasions (44% vs. 76%, p<0,014)

DISCUSSIONS AND CONCLUSIONS

1. AMI, tobacco, HTA and dislipemias are the most frequent risk factors in patients with IMC.
2. This is a group with a high morbility with a rate of AMI in five years of 67%. Only 10% of the patients remained unaffected during the study.
3. Unstable angina is the main cause of readmission followed by AMI.
4. Diabetics is linked to minor possibility of surgical revascularization, more admissions and higher AMI probability.
5. Only 72% survived after 5 years.

 

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2nd Virtual Congress of Cardiology

Dr. Florencio Garófalo
Steering Committee
President
Dr. Raúl Bretal
Scientific Committee
President
Dr. Armando Pacher
Technical Committee - CETIFAC
President
fgaro@fac.org.ar
fgaro@satlink.com
rbretal@fac.org.ar
rbretal@netverk.com.ar
apacher@fac.org.ar
apacher@satlink.com

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