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Determinants of operative mortality and long-term survival in patients with unstable angina. The CASS experience
Insights
Unstable angina surgery has low operative mortality, unrelated to presentation. Long-term survival depends on left ventricular function, other illnesses, and coronary disease extent.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Unstable angina is a critical condition requiring surgical intervention.
- Identifying factors influencing outcomes is crucial for patient management.
Purpose of the Study:
- To determine factors affecting operative mortality and long-term survival in 3,311 patients undergoing surgery for unstable angina.
- To assess the relationship between clinical presentation and surgical outcomes.
Main Methods:
- Analysis of data from 3,311 patients treated surgically for unstable angina.
- Logistic regression and Cox analysis to identify predictors of operative mortality and long-term survival.
Main Results:
- Overall operative mortality was 3.9%, with no significant differences based on clinical presentation.
- Age, left ventricular score, and left main stenosis predicted operative mortality.
- Left ventricular score, congestive heart failure score, comorbidities, extent of coronary disease, and cardiomegaly predicted long-term survival.
Conclusions:
- Operative mortality for unstable angina is low and not dependent on clinical presentation.
- Long-term survival is significantly influenced by left ventricular dysfunction, comorbidities, and coronary artery disease severity.
Abstract:
To identify the factors that determine operative mortality and long-term survival, we analyzed the data from 3,311 patients who underwent surgical therapy for unstable angina according to clinical presentation. Overall operative mortality was 3.9% and no differences in operative mortality were found between patients with coronary insufficiency, new-onset angina, rest angina, or changing patterns of angina. Logistic regression analysis indicated that age, left ventricular score, and presence of a left main stenosis in a left dominant circulation were related to operative mortality. The 7 year cumulative survival rate was 79%. Features predictive of long-term outcome by Cox analysis included left ventricular score, congestive heart failure score, other illness, extent of coronary disease, and cardiomegaly. Operative mortality of those patients who underwent coronary bypass during their initial hospitalization with unstable angina was similar to that of patients who were discharged and readmitted for operation at a later date. Thus, patients with unstable angina demonstrate a relatively low operative mortality, which is unrelated to the clinical presentation. Long-term survival is primarily determined by clinical and angiographic markers of left ventricular dysfunction, associated illness, and the extent of coronary disease.