The first decade of aortocoronary bypass grafting, 1967-1977. A review.

McIntosh, Henry D.; Garcia, Joseph A.

doi:10.1161/01.cir.57.3.405

Cited by 194 publications

(44 citation statements)

References 68 publications

(31 reference statements)

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“…3). The difference was not significant in patients who had a score B>10 (3-year survival rate 81% vs 87%, NS), perhaps because only a small number of patients who had a perioperative infarction were followed for 3 than death from all causes, the same significant trends were noted.…”

Section: Resultsmentioning

confidence: 84%

Use of survival analysis to determine the clinical significance of new Q waves after coronary bypass surgery.

et al. 1983

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SUMMARY There are few data on the long-term effects of new Q waves on survival and morbidity after coronary bypass graft surgery (CABG). We followed 1340 patients who underwent CABG in 1978 at 10 hospitals participating in the Coronary Artery Surgery Study (CASS). The incidence of perioperative Qwave infarction was 4.6% (range 0.0-10.3% by hospital). The rate of infarction was higher in patients who had an increased left ventricular end-diastolic pressure or cardiomegaly on the preoperative chest radiograph. Patients who received more grafts or who had longer cardiopulmonary bypass time were also at higher risk of infarction. In a stepwise discriminant analysis of 44 clinical, angiographic and surgical variables, cardiopulmonary bypass time, topical cardiac hypothermia and cardiomegaly entered the stepwise selection of variables.Long-term survival was adversely affected by the appearance of new postoperative Q waves. The hospital mortality was 9.7% in the 62 patients who had new postoperative Q waves and 1.0% in the 1278 patients who did not (p < 0.001); the 3-year cumulative survival rates were 85% and 95%, respectively (p < 0.001).In patients who survived to hospital discharge, the presence of new postoperative Q waves did not adversely affect 3-year survival (94% and 96%, respectively). The survival rates were worse in patients who had a history of infarction or who had impaired left ventricular function preoperatively. The number of readmissions to hospital after CABG among the patients who had a transmural perioperative infarction was similar to that among patients who did not.We conclude that the appearance of new Q waves after CABG adversely affects survival. The major impact on mortality occurs before hospital discharge. Patients who are destined to have a perioperative infarct cannot be predicted from commonly measured preoperative and angiographic variables.LEFT VENTRICULAR function is a major determinant of long-term survival in patients who undergo coronary artery bypass graft surgery (CABG).1-' Numerous studies have documented new wall motion abnormalities after CABG in patients who have sustained a perioperative infarction. Although worsened left ventricular performance theoretically should affect survival adversely, few studies have compared cumulative survival of patients who had a perioperative infarction with that of patients who have not.'0 '5 Perioperative myocardial infarction can be difficult to define. The postoperative development of new Q waves on the ECG, elevation of serum cardiac enzymes, or the finding of myocardial uptake of technetium-99 pyrophosphate have been proposed as diagnostic criteria for perioperative infarction.9' 15-18 However, the clinical significance of a single abnormal test result is still debated, particularly when the results of several tests are discordant.The reported ECG incidence of perioperative infarction ranges from 5.0% to 23.8%.'9-39 Several studies

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Section: Resultsmentioning

confidence: 84%

Use of survival analysis to determine the clinical significance of new Q waves after coronary bypass surgery.

et al. 1983

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“…Coronary revascularization improves dramatically the symptomatic status of patients with coronary artery disease and restores normal systolic and diastolic function in many patients with angina pectoris.20 22 Persistent elevation of left ventricular end-diastolic pressure during exercise after surgery (table 3) is thought to be the result of a parallel increase in end-diastolic volume.20 This increase in end-diastolic pressure is less than that before surgery and is not associated with clear 974 FIGURE 7. Transmural muscle fiber diameter (left) and transmural interstitial fibrosis (right) in patients with exercise-induced myocardial ischemia.…”

Section: Discussionmentioning

confidence: 99%

Myocardial structure in patients with exercise-induced ischemia.

et al. 1988

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“…1 2 Whether surgical treatment of symptomatic coronary artery disease improves ventricular function and prolongs life is controversial.2 This study reports the effect of CABG on left ventricular (LV) function assessed by biplane quantitative radionuclide angiography at rest and during sprint maximal and graded submaximal exercise before and 3 months after surgery.…”

mentioning

confidence: 99%

Radionuclide angiographic assessment of global and segmental left ventricular function at rest and during exercise after coronary artery bypass graft surgery.

Lim¹,

Kalff²,

Kelly³

et al. 1982

Circulation

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SUMMARY Left ventricular ejection fraction (LVEF) was measured by radionuclide angiography at rest and during supine bicycle exercise before and 3 months after coronary artery bypass graft surgery (CABG) in 20 patients with chronic stable angina. The CORONARY artery bypass graft surgery (CABG) relieves the pain of myocardial ischemia and improves quality of life. 1 2 Whether surgical treatment of symptomatic coronary artery disease improves ventricular function and prolongs life is controversial.2 This study reports the effect of CABG on left ventricular (LV) function assessed by biplane quantitative radionuclide angiography at rest and during sprint maximal and graded submaximal exercise before and 3 months after surgery. Patients and MethodsThe 20 subjects of this study were drawn from the 34 patients admitted to hospital for elective coronary angiography over a 7-month period because of refractory angina pectoris. They had no noncoronary heart disease and consented to enter the study. All 3,-adrenergic blocking medication was withdrawn 48 hours before commencing measurements, and nitrates were withheld for at least 12 hours. Biplane right anterior oblique (RAO) gated first-pass and left anterior

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The first decade of aortocoronary bypass grafting, 1967-1977. A review.

Cited by 194 publications

References 68 publications

Use of survival analysis to determine the clinical significance of new Q waves after coronary bypass surgery.

Use of survival analysis to determine the clinical significance of new Q waves after coronary bypass surgery.

Myocardial structure in patients with exercise-induced ischemia.

Radionuclide angiographic assessment of global and segmental left ventricular function at rest and during exercise after coronary artery bypass graft surgery.

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