SURGICAL RE-VASCULARIZATION FOR ACUTE CORONARY INSUFFICIENCY - ANALYSIS OF RISK-FACTORS FOR HOSPITAL MORTALITY

Background. A retrospective study of 444 patients undergoing urgent an d emergent coronary artery bypass grafting for acute coronary insuffic iency was performed to identify the risk factors for hospital death sp ecifically associated with the clinical severity of the acute coronary insufficiency syndrome. Methods. The patients were divided into three groups - urgent, emergent A, and emergent B - on the basis of the evo lution of the clinical pattern of the acute coronary insufficiency syn drome on full medical treatment. The three categories were defined as follows: urgent (257 patients), surgical revascularization could be de layed for 24 to 36 hours after surgical consultation because of adequa te control of ischemia; emergent A (127 patients), prompt myocardial r evascularization was required because medical treatment achieved only transient regression of an unrelenting ischemic pattern; and emergent B (60 patients), prompt myocardial revascularization was required beca use the acute coronary insufficiency was entirely refractory to medica l treatment. Results. Mortality rates were 7.4% for the urgent group, 13.4% for the emergent A group, and 31.7% for the emergent B group. Mu ltivariate analysis identified the following as risk factors for hospi tal mortality: ejection fraction (p = 0.023) and aortic cross-clamp ti me (p = 0.10) for:he urgent group; aortic cross-clamp time (p = 0.017) , ejection fraction (p = 0.03), and nonuse of blood cardioplegia (p = 0.04) for the emergent A group; and cardiogenic shock (p = 0.00), preo perative ischemic interval (p = 0.00), aortic cross-clamp time (p = 0. 018), and nonuse of blood cardioplegia (p = 0.012) for the emergent B group. Conclusions. A more exact definition of patient risk can be ach ieved when predictive outcome models are constructed using the risk fa ctors specifically related to each level of clinical severity of the i schemic syndrome. (C) 1997 by The Society of Thoracic Surgeons.