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Unstable angina pectoris. Factors influencing operative risk
Insights
Coronary artery bypass grafting (CABG) for unstable angina has low mortality when high-risk factors like advanced age or poor heart function are absent. Excluding these factors reveals CABG mortality for unstable angina is comparable to stable angina.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Thoracic Surgery
Background:
- Coronary artery bypass (CAB) surgery is a common treatment for coronary artery disease.
- Assessing mortality risk factors in CAB surgery for different angina types is crucial for patient management.
Purpose of the Study:
- To evaluate the hospital mortality rates associated with coronary artery bypass (CAB) surgery.
- To identify risk factors influencing operative mortality in patients undergoing CAB for stable versus unstable angina pectoris.
- To determine the safety of CAB for unstable angina when specific risk factors are absent.
Main Methods:
- Retrospective review of 471 consecutive patients undergoing isolated coronary artery bypass (CAB) operations.
- Analysis of hospital mortality rates stratified by angina type (stable vs. unstable) and presence of risk factors.
- Identification of factors associated with increased operative mortality, including age >70, poor left ventricular function, unfavorable distal vessels, and main left coronary artery disease.
Main Results:
- Overall hospital mortality for CAB was 2% in stable angina (341 patients) and 7.7% in unstable angina (130 patients).
- Increased mortality risk factors included age >70, poor left ventricular function, unfavorable distal vessels, and main left coronary artery disease.
- In unstable angina patients without these risk factors (78 patients), mortality was low at 1.3%.
- Excluding elderly patients and those with poor left ventricular function or unfavorable distal vessels, CAB mortality for unstable angina (2.0%) was similar to stable angina.
Conclusions:
- Age >70, poor left ventricular function, unfavorable distal vessels, and main left coronary artery disease are associated with increased operative mortality in CAB surgery.
- Coronary artery bypass (CAB) surgery for unstable angina carries a low hospital mortality rate when high-risk factors are absent, comparable to rates for stable angina.
- Risk stratification is essential for optimizing outcomes in patients undergoing CAB surgery for unstable angina.
Abstract:
Experience was reviewed with 471 consecutive patients who had coronary artery bypass (CAB) operation alone. The hospital mortality rate was 2% in 341 patients operated on for treatment of stable angina pectoris. There were ten deaths (7.7%) in the 130 patients who underwent CAB for treatment of unstable angina. In this series, age greater than 70 years, poor left ventricular function, distal coronary arteries unfavorable for grafting and the presence of main left coronary artery disease were factors associated with increased operative mortality. In 78 patients with unstable angina who had none of these increased risk factors, the mortality rate was 1.3%. Hospital mortality was 33% in patients older than 70 years and 29% in patients with poor left ventricular function and/or distal vessels unfavorable for grafting. In 23 of the 130 patients, the only increased risk factor present was severe stenosis of the main left coronary artery and one of them (4.3%) died. Thus, when elderly patients and patients with poor left ventricular function or poor distal vessels were excluded, the hospital mortality rate associated with CAB in patients with unstable angina was low (2.0%, 2/101 patients) and equal to that for operation in patients with stable angina pectoris.