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Mortality Prognostic Factors in
Multivessel Ischemic Cardiopathy.
Five-Year Monitoring

Sanchez-Rubio, Juan; Galache, José G.;
Chopo, José M.; Ondiviela, Jorge;
Molinero, Edmundo; Salazar, José;
Calvo, Isabel; Diarte, José A.; Placer, Luis J.

Hospital Universitario Miguel Servet, Zaragoza, Spain

SUMMARY
Background and aims: Multivessel ischemic cardiopathy (MIC) patients show high mortality. We try to identify factors in our medium that can predict mortality.
Methods: Monitoring a sample of 70 consecutive patients that were diagnosed MIC in 1995, with lesions >60% in at least two vessels. Variables taken are age, tobacco, diabetes mellitus (DM), hyperlipidemia (HL), angor pectoris history, previous AMI, EF, LAD lesion >60%, AMI during monitoring and revascularization. Two groups were established: deceased patients and patients living after 5 years. Statistical analysis was performed with t-Student for quantitative variables, and Mann-Whitney and X2 as non-parametrical tests. Data were obtained from clinical history and interviews during December 2000.
Results: A 57 months mean monitoring per patient was done (1-70, sd 21.2). Mortality after 5 years was 28%. Statistically significant comparative results are shown in the Table 1 below.

Conclusions: 1) Mortality in MIC patients regarding age, tobacco addiction or hyperlipidemia is not higher. 2) Factors predicting higher mortality are DM, previous angor history, previous AMI, depressed EF, non revascularization and AMI occurrence during monitoring. 3) The main survival predictor was revascularization. 4) All deceased had the LAD affected.

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INTRODUCTION
   The patients affected by multivessel ischemic cardiopathy constitute a group of patients with a high mortality rate. It is often difficult to carry out a vital prognosis due to the high number of risk factors and clinical markers involved in its evolution.

OBJETIVES
   Try to identify independent factors which will predict mortality in patients with multivessel coronary disease in our enviroment.

METHOD
   We carried out a follow-up study on 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 coronary affection. After a period of 5 years we established two groups: one with deceased patients and another with living patients. We obtained the data through revision of the clinical histories and interviews in december 2000.

  We chose as variables diverse risk factors and clinical markers: age, sex, addiction to tobbaco, hypertension, diabetes mellitus -DM-, dislipemia -DL-, angor history, previous AMI, left ventricular ejection fraction -LVEF-, affected coronaries, AMI during monitoring and revascularization (surgical or percutaneous).

   We carried out the statistical analysis using the T-Student for cuantitative variables and the Mann-Whitney and X2 non-parametrics tests.

RESULTS
   The mean age of the 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). The risks factors of the study population are shown in table 1. The mortality observed was 28% (cardiogenic origin 18%, cardiovascular 3,4%, and other causes 6,6%). The results obtained in the independent analysis of each variable are shown in table 2, toghether with statistic interpretation.

    The indicators of the highest mortality which were statistically significant were: DM, previous angor, antecedents of AMI, depressed LVEF, non-revascularized patients, AMI during the 5 years of monitoring. We did not find any relationship between the affectation of different territories (LAD, RC or CX) and the increase in mortality. Surprisingly, in the group of deceased patients 29% smoked while in the group of living patients the percentage was higher (65,9%). This fact could lead us to infer that non-smokers show a higher mortality than smokers. However, carring out a more detailed analysis we found that the average age in the group of patients who were smokers was 64 years versus 72,7 years in the group of non-smokers. We think that the increase in mortality in the group of non-smokers is due to older age (64 vs 72,7, p<0.002). Besides this datum tells us that the habit of smoking accelerates coronary ateroesclerosis making the disease appear at a younger age.

CONCLUSIONS

1. Mortality is not higher in MIC patients depending on age, tobacco addiction or hyperlipidemia
2. Factors predicting higher mortality are DM, previous angor history, previous AMI, depressed LVEF, non-revascularization and AMI ocurrence during monitoring.
3. The main survival predictor was revascularization.
4. 100% deceased had the LAD afected.
5. Smokers present the disease at an earlier ege (average of 8 years before)

 

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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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