Urgent surgical revascularization of unstable angina. Influence of double mammary arteries

Objective: Aim of this study was to evaluate retrospectively: (1) the outco me in patients with unstable angina (UA) refractory to the medical therapy undergoing urgent-emergent CABG (2) the influence of both IMAs employment. Patients and methods: Between January 1995 and July 2000. 576 (28.5%) conse cutive patients with UA underwent CABG procedure. 182 (31,6%. Group I) pati ents, presenting unstable hemodynamic or angina pectoris refractory to the maximal medical therapy, underwent urgent/emergent CABG. 397 (68.4%, Group II) patients, after the maximal medical therapy did not present angina's ep isodes or ECG alterations and underwent elective CABG procedure. Preoperati ve data were similar in the two groups. Both IMAs were used in 68 (37.4%) p atients of I and 152 (38%) of II (P > 0.05) to left side revascularization. Results: CAD extension was greater in Group I: 45 (24.7%) patients present ed ischemia in >1 area vs 53 (13.5%) in II (P < 0.001). Incidence of antero septal ischemia resulted significantly higher in I (P = 0.017): left main c oronary artery stenosis was present in 68 (37%) patients in 1 vs 108 (27%) in II (P = 0.01). LV function resulted significantly depressed in I. demons trated by a significantly lower LVEF (P < 0.001), higher NYHA class (P < 0. 001) and preoperative incidence of IABP (P < 0.001). Intraoperative data an alysis did not reveal any difference between groups, Hospital mortality was 13 (7%) and 21 (5.3%) patients in I and II respectively (P = ns). Multivar iate analysis of all preoperative and intraoperative variables revealed the age > 65 years (P = 0.01), congestive heart failure (P < 0.001), LVEF < 35 % (P = 0.03). >1 ischemic area (P = 0.02) as strong predictors for poor ove rall survival. and LIMA (P = 0.006) and both IMAs (P = 0.001) as strong pre dictors for good overall survival. Actuarial survival at 1, 3 and 5 years r esulted to be 98.5, 96.5 and 90% in I and 99, 96 and 92% in II (P = ns). Co nclusion: CABG has been associated with acceptable outcome in patients with UA which should be applied soonest possible in patients refractory to medi cal treatment. Total coronary revascularization and employment of both IMAs for left myocardial side are associated with low operative risk and incide nce of complications, permit to have acceptable short and long-term outcome in this pool of patients. (C) 2001 Elsevier Science BN. All rights reserve d.