Related Experiment Videos
Early and late mortality after surgery for unstable angina in relation to Braunwald class
1Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden.
Insights
Unstable angina patients with higher Braunwald class face increased early death risk after urgent coronary artery bypass grafting (CABG). Long-term survival is similar for stable and unstable angina patients post-CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Outcomes Research
Background:
- Prognostic value of preoperative Braunwald classification for unstable angina remains unstudied.
- Urgent coronary artery bypass grafting (CABG) outcomes for unstable angina require further investigation.
Purpose of the Study:
- To evaluate the prognostic significance of the preoperative Braunwald class in unstable angina patients undergoing urgent CABG.
- To compare early and long-term outcomes between unstable and stable angina patients after CABG.
Main Methods:
- Retrospective analysis of 992 unstable and 5376 stable angina patients undergoing isolated CABG (1980-1995).
- Patients were classified using the Braunwald system based on symptom severity.
- Mortality rates (30-day, 1-6 months, up to 5 years) were recorded and analyzed.
Main Results:
- Early mortality was significantly higher in unstable angina patients (4.6%) compared to stable angina patients (1.6%).
- Higher Braunwald classes (IIIB, IIIC) in unstable angina correlated with increased early death risk (OR 4.3-4.7).
- Long-term survival rates (beyond 6 months) were comparable between stable and unstable angina groups.
Conclusions:
- Preoperative Braunwald class is a significant predictor of early mortality in unstable angina patients undergoing urgent CABG.
- While early risks are elevated for unstable angina, long-term survival post-CABG is similar to stable angina patients.
- Braunwald classification aids in risk stratification for urgent CABG in unstable angina.
Background:
The prognostic value of the preoperative Braunwald class of unstable angina to predict early and long-term outcome after urgent coronary artery bypass grafting (CABG) has not been studied previously.
Methods:
Deaths were recorded after all primary isolated CABG performed for unstable (n = 992) and stable (n = 5376) angina pectoris during 1980-1995. Severity of symptoms in the unstable patients was classified according to Braunwald.
Results:
Death within 30 days of surgery occurred in 4.6% of the patients having unstable angina and in 1.6% of those with stable angina. Early mortality was 2.5% in Braunwald class II, 4.9% in class IIIB, and 6. 2% in class IIIC unstable patients. The risk of early death, after adjustment for risk factors, was about four times higher in Braunwald class IIIB (odds ratio [OR] 4.3, 95% confidence interval [CI] 2.4-7.7) and IIIC (OR 4.7, 95% CI 2.2-10.3) patients than in stable patients. The risk of death during postoperative months 1 to 6 tended to be higher (relative risk 2.4, 95% CI 0.8-7.1) in Braunwald class IIIC patients than in stable patients. After the first 6 months up to 5 years, survival rates in all Braunwald classes were similar to those in patients operated on for stable angina.
Conclusions:
There was a higher risk of early death after urgent bypass surgery in patients with Braunwald class III unstable angina than after elective CABG. The long-term survival rates after the first 6 postoperative months was similar in stable and unstable patients, regardless of preoperative Braunwald class.