CURRENT RISK OF CORONARY-BYPASS FOR UNSTABLE ANGINA

被引:24
作者
FREMES, SE
GOLDMAN, BS
CHRISTAKIS, GT
IVANOV, J
WEISEL, RD
SALERNO, TA
DAVID, TE
机构
[1] Divisions of Cardiovascular Surgery, University of Toronto, Toronto, ON
关键词
UNSTABLE ANGINA; OPERATIVE MORTALITY;
D O I
10.1016/1010-7940(91)90170-O
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The risk associated with surgical revascularization for unstable angina is critically dependent upon the clinical presentation of the patient. For this study, between January 1982 and December 1987, clinical, angiographic, operative and hospital outcome data were collected prospectively for 6539 patients undergoing surgery for unstable angina. Urgent surgery was performed in 1523 patients (23.3%), while 5016 (76.7%) underwent semielective revascularization. The mean age was 58.9 +/- 9.2 years and 805 patients (12.3%) were aged 70 years or above. The male:female ratio was 3.6:1. Depressed left ventricular function (left ventricular ejection fraction < 40%) was present in 27.2% of the population. Preoperative myocardial infarction (within 30 days of surgery) had occurred in 588 patients (9.0%). Operative mortality was 4.6% (301 deaths). Stepwise logistic regression analysis was performed to determine the independent predictors of operative mortality. The following variables were selected in descending order: urgent surgery (P < 0.001), coronary reoperation (P < 0.001), depressed left ventricular (P < 0.001), female gender (P < 0.001), increasing age (P < 0.001), left main stenosis (P = 0.002), and preoperative myocardial infarction (P < 0.001). Predicted operative mortality varied between 0.5 +/- 0.3% and 82.6 +/- 12.7%. The most important determinant for patients with a preoperative myocardial infarction was left ventricular dysfunction, whereas urgent surgery for unstable angina was the most important risk variable in those without preoperative necrosis.
引用
收藏
页码:235 / 243
页数:9
相关论文
共 42 条
[1]  
Ahmed M., Thompson R., Seabra-Gomes R., Rickards A., Yacoub M., Unstable angina: A clinicoarteriographic correlation and long-term results of early myocardial revascularization, J Thorac Cardiovasc Surg, 79, pp. 609-616, (1980)
[2]  
Bounous E.P., Mark D.B., Pollock B.G., Hlatky M.A., Harrell F.E., Lee K.L., Rankin J.S., Wechsler A.S., Pryor D.B., Califf R.M., Surgical survival benefits for coronary disease patients with left ventricular dysfunction, Circulation, 78, pp. 1-157, (1988)
[3]  
Brawley R.K., Merit W., Gott V.L., Donahoo J.S., Watkins L., Gardner T.J., Unstable angina pectoris - factors influencing operative risk, Ann Surg, 191, pp. 745-750, (1980)
[4]  
Breyer R.H., Engelman R.M., Rousou J.A., Lemeshow S., Postinfarction angina: An expanding subset of patients undergoing coronary artery bypass, J Thorac Cardiovasc Surg, 90, pp. 532-540, (1985)
[5]  
Brown C.A., Hutter A.M., Desanctis R.W., Gold H.K., Leibach R.C., Roberts-Niles A., Austen W.G., Buckley M.J., Prospective study of medical and urgent surgical therapy in randomiz- able patients with unstable angina pectoris
[6]  
results of inhospital and chronic mortality and morbidity, Am Heart J, 102, pp. 959-964, (1981)
[7]  
Principal Investigators C., Associates T., Coronary artery surgery study (CASS): A randomized trial of coronary artery bypass surgery, Circulation, 68, pp. 939-950, (1983)
[8]  
Christakis G.T., Ivanov J., Weisel R.D., Bimbaum P.L., David T.E., Salerno T.A., The changing pattern of coronary bypass surgery, Circulation, 80, pp. 1.151-1.161, (1989)
[9]  
Christakis G.T., Fremes S.E., Weisel R.D., Madonik M.M., Mc Donough J.H., Tittley J.G., Mickle D., Ivanov J., Mickleborough L.L., Goldman B.S., Baird R.J., Reducing the risk of urgent revascularization for unstable angina, J Vase Surg, 3, pp. 764-772, (1986)
[10]  
Cosgrove D.M., Lytle F.D., Lytle B.W., Baillot R., Gill C.C., Golding L., Taylor P.C., Goormastic M., Primary myocardial revascularization - trends in surgical mortalit, J Thorac Cardiovasc Sur, 8, pp. 673-768, (1984)