Prospective evaluation of corollary arteries: influence on operative risk in coronary artery surgery

Objective: Coronary angiography data included in the analysis of operative mortality after coronary artery surgery are generally limited to left main coronary artery stenosis and classification into one-, two- or three-vessel disease, but the role of stenoses and quality of distal runoff on each mai n coronary artery have never been analysed. The aim of this study was to as sess the influence of coronary artery status (stenoses and distal runoff) o n operative mortality in patients undergoing coronary artery surgery. Metho ds: Stenoses of the five main coronary arteries and their distal runoff wer e prospectively evaluated in a series of 2461 patients undergoing isolated coronary artery surgery. These angiographic variables were included in anal ysis of operative mortality in combination with conventional preoperative d ata. Results: Univariate analysis founded 21 preoperative variables being s ignificant: age >70, body surface area <1.8 mi, arterial disease of lower l imbs, history of peptic ulcer, CCS class IV angina, unstable angina, post-i nfarction unstable angina, congestive heart failure, left ventricular eject ion fraction <50%, urgency, preoperative intra-aortic balloon pump, previou s myocardial infarction, previous cardiac surgery, previous coronary bypass graft, presence of significant stenosis on the left main coronary artery o r the circumflex marginal branch or the distal circumflex artery or the rig ht coronary artery, absence of significant stenosis on the left anterior de scending artery, impaired distal runoff on the left anterior descending art ery or the circumflex marginal branch (for all, P < 0.05). Multivariate ana lysis identified poor quality distal runoff in the left anterior descending artery and circumflex marginal branch as independent risk factor (P = 0.00 05 and P = 0.04, respectively), while left main coronary artery stenosis wa s not. This lesion appears to be a significant risk factor only in a small subgroup of patients with CCS class IV angina. Other independent risk facto rs were CCS class IV angina, previous cardiac surgery, body surface area <1 .8 m(2) diabetes mellitus, age <70, history of peptic ulcer, left ventricul ar ejection fraction <50%. Impaired distal runoff or the presence of stenos es on the diagonal branch, right coronary artery, or distal circumflex arte ry does not significantly influence the operative mortality rate. Conclusio ns: The quality of distal runoff of the most frequently grafted vessels is a significant risk factor for operative mortality in coronary artery surger y. Left main coronary artery stenosis was not identified as a risk factor w hen these angiographic variables were included in the analysis. Functional status remains the most powerful predictive factor. (C) 1999 Elsevier Scien ce B.V. All rights reserved.