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Unstable angina: early and late results of operative treatment
Insights
Coronary artery bypass grafting (CABG) for unstable angina showed low mortality, especially when performed alone. CABG alone had a 3.5% mortality rate, comparable to stable angina patients.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Unstable angina presents a significant challenge in cardiac surgery.
- Coronary artery bypass grafting (CABG) is a primary treatment for severe coronary artery disease.
Purpose of the Study:
- To evaluate the peri-operative mortality of patients undergoing CABG for unstable angina.
- To compare outcomes of CABG alone versus CABG with additional procedures in unstable angina patients.
Main Methods:
- Retrospective analysis of 68 consecutive patients with unstable angina undergoing CABG between January 1978 and May 1980.
- Stratification of patients into two groups: CABG alone and CABG with additional surgical procedures.
Main Results:
- Overall peri-operative mortality for unstable angina patients was 7.4% (5 deaths).
- Patients undergoing CABG alone had a peri-operative mortality of 3.5% (2 deaths), which was not significantly higher than stable angina CABG mortality (2.4%).
- Patients requiring additional procedures (e.g., valve replacement) had a significantly higher peri-operative mortality of 27% (3 deaths).
Conclusions:
- CABG for unstable angina, when performed without additional complex procedures, demonstrates an acceptable peri-operative mortality.
- The findings suggest that CABG alone is a safe and effective option for selected unstable angina patients, with outcomes comparable to those undergoing CABG for stable angina.
Abstract:
Between January 1978 and May 1980 at King's College Hospital 68 patients of 300 patients treated consecutively by coronary artery bypass grafting (CABG) had presented with unstable angina. There were 58 males and 10 females age range 26 to 69 years, mean 54 years. Thirty-one patients (45%) had definite evidence of previous myocardial infarction, 4 had diabetes mellitus and 7 had left main stem stenosis greater than 50%. Seven cases (9.7%) required pre or peri-operative intra-aortic balloon pump assistance. Two subsets within this group of 68 patients with unstable angina were recognised. Fifty seven patients had CABG alone without any additional surgical procedure and there were 2 peri-operative deaths (mortality 3.5%). In 11 patients who had CABG plus additional surgical procedures including valve replacement or left ventricular aneurysmectomy there were 3 peri-operative deaths (mortality 27%). The overall mortality of the 68 patients was 5 deaths (7.4%). These results indicate that the operative mortality in patients with unstable angina having CABG alone is not significantly higher than the overall mortality at that time for the patients who had CABG for stable angina (2.4%).