Risk Factors for operative mortality and morbidity in patients undergoing coronary artery bypass surgery for stable angina pectoris

Abstract

Risk factors for a poor early outcome of surgery for stable angina pectoris were evaluated in 2659 consecutive patients from a defined population. The total operative mortality (death within 30 days after surgery) was 2.6% and the frequency of myocardial injury (increase in S-ASAT to greater than 2.0 mu kat l-1 and in S-CKMB to greater than 1.5 mu kat l-1 within 48 h postoperatively or death in the operating room) 14%. Mortality was related to New York Heart Association (NYHA) classification (P less than 0.001), age (less than or greater than 70 years, P = 0.001), duration of symptoms (less than or greater than 8 years, P = 0.001), aortic cross-clamp (ACC) time (P less than 0.001), and cardiopulmonary bypass (CBP) time (P less than 0.001). A multivariate analysis showed that the combination of NYHA class, ACC time and age best predicted operative mortality. Myocardial injury was related to NYHA functional class (P less than 0.001), duration of symptoms (P less than 0.001), regrafting procedure (P less than 0.001), cardiac related dyspnoea (P = 0.015), ACC time (P = 0.001), CPB time (P = 0.001), relative volume of cardioplegic solution (P less than 0.001), and thromboendarterectomy procedure (P = 0.004). The set of variables that best predicted myocardial injury consisted of ACC time, relative volume cardioplegic solution, NYHA class, regrafting procedure and duration of symptoms. However, these risk factors indicated only moderately high risks, and high-risk patients could not be selected with sufficient accuracy.

Electrical Stimulation Versus Coronary Artery Bypass Surgery in Severe Angina Pectoris

“…6,7,9,13,14 Revascularization procedures, ie, coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA), are standard treatments in severe angina pectoris. There are several groups of patients for whom CABG is known to be associated with an increased complication risk, eg, patients with unsuitable coronary anatomy requiring extended surgical procedures 15 ; patients with low ejection fractions 16 ; patients with concomitant extracardiac disease such as diabetes mellitus, 17 renal dysfunction, 18 cerebrovascular disease, 18 -20 or peripheral vascular disease 21 ; and patients who have previously undergone CABG. 15,17 Until now, SCS has been used in the treatment of severe angina pectoris despite optimum medication in patients who are not accessible for revascularization.…”

Risk factors for acute myocardial infarction during the postoperative period of myocardial revascularization

“…Acute myocardial infarction in the postoperative myocardial revascularization period is a complication that results in worse evolvement in a short-and long-term [14][15][16][17][18] . Several studies have reported measures that aim at decreasing the incidence of acute myocardial infarction in the postoperative period, in particular enhancement of myocardial protection techniques, enhancement of surgical technique (for example, use of arterial grafts, of circulatory support (especially intraaortic balloon), and pharmacological advances 19,20 .…”

ACC/AHA 2004 guideline update for coronary artery bypass graft surgery

“…Other correlates of increased risk include increasing age; recent MI (less than 30 days), especially in the presence of unstable angina, left main disease, or 3-vessel disease; emergency or urgent coronary bypass; reoperation; reduced renal function; cerebrovascular disease; COPD; a smoking history; obesity; and female sex (21,(445)(446)(447)(448)(449)(450)(451)(452). A higher operative mortality occurs for all identified risk factors in patients aged 75 years or older than for those less than 65 years old.…”

“…Operative factors that have been reported to adversely influence hospital mortality in the elderly include the use of bilateral IMA grafts, prolonged pump time and/or crossclamp time, an increased number of grafts required, right IMA grafting, and any postoperative complication (448,449,457,458). Obesity has been identified as a risk factor for infection in patients receiving bilateral IMA grafts (457).…”