Abstract
Aims
To evaluate current lifestyle, secondary medical prevention and objective physical abilities in long-term survivors after coronary artery bypass grafting (CAGB).
Methods and results
Data were collected by written questionnaires and telephone interviews in 476 (405 men, mean age 56 years) patients after a median follow-up of 16.6 yrs (95% CI 16.5–16.7 yrs post-CABG). Triple-vessel coronary heart disease (CHD) was present in 56%; combined arterial and venous revascularization was performed in 21% of patients and 83% received complete revascularization. All patients are today under continuous medical therapy (1–10 drugs, mean 3.8±0.08) and the majority of patients (49%) undergo daily administration of 3–4 drugs. Present cardiovascular risk profiles include overweight (52% with a BMI of >25 kg/m2), arterial hypertension (44%), hyperlipidemia (66%, of whom 22% are without lipid-lowering therapy) and diabetes (21%, of whom 27% are without glucose-lowering therapy). Seventy-three percent of patients are today in NYHA class I or II. Angina or dyspnea during stress affect 35% and 47% of patients, respectively. Mean ergometric stress testing level was 107±3 W and 43% of patients were found to perform at >100 W. Acute myocardial infarction re-occurred in 26% and ≥1 occluded graft was found in 24% of patients; the frequency of re-CABG was 21% after a mean of 11±0.4 yrs.
Conclusion
Long-term survivors after CABG procedure show excellent clinical conditions and physical abilities despite suboptimal secondary prevention of CHD in medial therapy and lifestyle issues. The cause(s) of the fortunate outcome in this “highly responsive” group remain to be illuminated.
Zusammenfassung
Ziel
Wir untersuchten den aktuellen Lebensstil, sekundär-präventive medikamentöse Maßnahmen und die objektive physische Belastbarkeit von Langzeitüberlebenden nach aortokoronarer Bypassoperation.
Methoden und Ergebnisse
Die Datensammlung erfolgte anhand eines postalischen Fragebogens sowie durch Telefoninterviews bei 476 Patienten (405 Männer, mittleres Alter 56 Jahre) nach einer medianen Zeit von 16,6 Jahren nach Bypassoperation (95% CI 16,5–16,7 Jahre). Eine koronare Dreigefäßerkrankung fand sich bei 56% des Kollektivs, 21% der Patienten erhielten eine kombinierte arterielle und venöse Revaskularisierung und 83% wurden komplett revaskularisiert. Alle Patienten stehen heute unter einer kontinuierlichen Medikation (1–10 Medikamente, im Mittel 3,8±0,08) und die Meherzahl der Patienten (49%) nimmt täglich 3–4 Präparate ein. Das kardiovaskuläre Risikoprofil zum Zeitpunkt der Datenerhebung beinhaltet Übergewicht (52% mit einem BMI >25 kg/m2), arterielle Hypertension (44%), Hyperlipidämie (66%, davon 22% ohne lipidsenkende Therapie) und Diabetes mellitus (21%, davon 27% ohne blutzuckersenkende Therapie). 73% der Patienten sind heute in der NYHA Klasse I oder II. Angina oder Dyspnoe bei Belastung beschreiben 35% bzw. 47% der Patienten. Die mittlere ergometrische Belastbarkeit der untersuchten Population beträgt 107±3 W und 43% der Patienten leisten >100 W. Ein erneuter Myokardinfarkt nach erfolgter Bypassoperation trat bei 26% der Fälle auf, ≥1 verschlossener Bypassgraft fand sich bei 24% der untersuchten Patienten und 21% unterzogen sich nach im Mittel 11±0,4 Jahren einer erneuten aortokoronaren Bypassoperation.
Schlussfolgerung
Langzeitüberlebende nach aortokoronarer Bypassoperation zeigen heute trotz suboptimaler sekundärpräventiver Maßnahmen im Bereich der Medikation und des Lebensstils exzellente Befunde hinsichtlich klinischem Status und physischer Belastbarkeit. Die Gründe für den vorteilhaften Verlauf in dieser „Responder-Gruppe“ bleiben offen.
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Hiemann, N.E., Zarubova, P., Dorbar, F. et al. The paradox of excellent long-term survival and physical fitness after coronary artery bypass surgery despite suboptimal secondary prevention. Z Herz- Thorax- Gefäßchir 21, 243–249 (2007). https://doi.org/10.1007/s00398-007-0597-x
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DOI: https://doi.org/10.1007/s00398-007-0597-x
Key words
- coronary heart disease
- coronary artery bypass grafting
- prognosis
- secondary prevention
- long-term survival