OPERATION FOR UNSTABLE ANGINA-PECTORIS - FACTORS INFLUENCING ADVERSE IN-HOSPITAL OUTCOME

Citation
Yag. Louagie et al., OPERATION FOR UNSTABLE ANGINA-PECTORIS - FACTORS INFLUENCING ADVERSE IN-HOSPITAL OUTCOME, The Annals of thoracic surgery, 59(5), 1995, pp. 1141-1149
Citations number
22
Categorie Soggetti
Surgery
ISSN journal
00034975
Volume
59
Issue
5
Year of publication
1995
Pages
1141 - 1149
Database
ISI
SICI code
0003-4975(1995)59:5<1141:OFUA-F>2.0.ZU;2-M
Abstract
Coronary artery bypass grafting for the treatment of unstable angina i s still associated with increased operative risk and postoperative mor bidity. The impact of the extended use of arterial grafts on early res ults is incompletely defined. In a 7-year period (1986 to 1993), 474 p atients (average age, 65 years; range, 34 to 85 years) underwent coron ary artery bypass grafting for the treatment of unstable angina. Sixty -eight patients were operated on emergently and 406 urgently. They rec eived an average of 3.0 distal anastomoses (range, 1 to 6). Seventy-ni ne patients had exclusively venous grafts, 316 had one internal thorac ic artery graft, 79 had bilateral internal thoracic artery grafts, and 20 had inferior epigastric artery grafts. Sequential internal thoraci c artery grafting was performed in 70 patients. Redo operations were p erformed in 26 patients. Thirty-four patients (7.2%) experienced a new myocardial infarction. Eighty-nine patients (18.8%) had an intraaorti c balloon pump inserted preoperatively, intraoperatively, or postopera tively. Eight patients (1.7%) died intraoperatively and 24 patients (5 .1%) died postoperatively. Seventy-seven patients (16.2%) had an adver se outcome, as shown by the need for an intraaortic balloon pump (intr aoperatively or postoperatively) or hospital death, or by both. Forty variables were examined by multivariate analysis for their influence o n the occurrence of an adverse outcome. Aortic cross-clamp time (p = 0 .0004), transfer from the intensive care unit (p = 0.0023), female sex (p = 0.0023), operation performed in early years (p = 0.0041), left v entricular aneurysm (p 0.0068), the number of diseased coronary vessel s (p = 0.0312), and reoperation (p = 0.0318) were all found to be sign ificant independent predictors of increased risk. Thus, aortic cross-c lamp duration remains the main determining factor of postoperative hos pital outcome, which suggests the need for improved myocardial protect ion techniques. Outcome was not found to be adversely affected by the extended use of arterial grafts.