Quality of life in patients with severe left ventricle dysfunction due to coronary artery disease

摘要

Background: The majority of randomized trials comparing surgical treatment with percutaneous coronary intervention exclude patients with severe left ventricle dysfunction, resulting in the lack of a clear strategy for treatment. Aim: Retrospective post treatment evaluation of New York Heart Association classification (NYHA) and quality of life (QOL) in patients submitted to different methods of treatment. Methodology: Patients with Left Ventricle Ejection Fraction (LVEF) ≤ 30% and verified atherosclerotic lesions in their coronary arteries were divided into groups depending on the method of treatment: 1. Pharmacological Treatment (PT). 2. Coronary Artery Bypass Graft (CABG). 3. Percutaneous Coronary Intervention (PCI). NYHA classification and the quality of life were assessed during follow-up examination performed after the mean time of 28,16 months in all three groups. All patients received pharmacological treatment of heart failure according to current guidelines. Results: Finally, 120 consecutive patients with severe dysfunction of left ventricle were enrolled in the study. Quality of Life was assessed after the mean time of 28,16 months in all three groups. QOL improved in the 58 percent of the patients in the pharmacological treatment group, 40 percent of the patients in the CABG group and 48 percent of the patients in the PCI group. Comparison between the groups did not reveal statistically significant differences: group 1 vs. 2 (p=0.48), 2 vs. 3 (p=1.0), 1 vs. 3 (p=0.11). The improvement of NYHA class in group of patients submitted to CABG treatment comparing to those patients who were only pharmacologically treated occurred in 8 patients and was statistically significant (p=0.00256). Improvement of NYHA class was achieved in 20 patients from the Pharmacological comparing to PCI group (p=0.055) and in 19 patients from the CABG comparing to PCI group (p=0.044) however these differences were not statistically significant. Conclusions: Improvement of NYHA functional class in patients with severe left ventricular dysfunction was statistically significant in patients submitted to CABG comparing to pharmacological treatment (p=0.00256). Improvement of QOL in particular groups was not statistically significant.