Original article Prognostic factors in patients with advanced multi-vessel coronary artery disease

Abstract

Background: Multivessel coronary artery disease (CAD) not suitable for revascularisation remains a challenge for present cardiology. Due to high mortality and difficulties in pharmacological therapy patients with this particular disease constitute a group of great interest.
Aim: To define the main unfavourable prognostic factors in patients with clinically stable multivessel CAD who do not qualify for percutaneous or surgical revascularisation.
Methods: The analysed group consisted of 106 patients (79 men, 66±8 years) with multi-vessel CAD, confirmed in coronary angiography, who were primarily disqualified from interventional treatment. Thirty-eight (36%) of them had diabetes and 5 (5%) had a previous stroke. The left ventricular ejection fraction was 37±15%, and mean Gensini score – 72±34.
Results: During 7.4±4 years of follow-up, 19 (18%) patients died. Predicting factors of mortality included older age (p=0.014), higher heart rate (p=0.02), diabetes (0.003), renal failure (p=0.0003), heart failure (p=0.013), past stroke (p=0.006) and lower left ventricular ejection fraction (p=0.0012). In multivariate logistic analysis the only significant parameter related to prognosis was decreased level of haemoglobin (p=0.007) and elevated leucocytosis (p=0.002). The ROC curves analysis showed that decreased Hgb (<12.3 g/dl) and increased leucocytosis (>11.3 t/mm³) were significantly associated with higher mortality (HR 6.3).
Conclusions: In patients with multi-vessel CAD not amendable revascularization the haemoglobin level and leucytosis seem to be at least as important as well known risk factors. More intensive complex pharmacotherapy and innovatory cell and gene therapeutic methods may improve the prognosis in this group of patients.