Predictors of perioperative mortality in patients with unstable postinfarction angina.
Factors associated with increased operative mortality in patients with postinfarction angina have not been defined. Two hundred twenty-five patients underwent urgent coronary artery bypass grafting from 1982 through 1986. One hundred sixty-two men and 63 women averaged 62 years of age (range, 35-87 years). Operative mortality was 5.3%. To assess the predictors of perioperative mortality, 16 variables were evaluated by univariate and multivariate analyses. Significant independent predictors of perioperative mortality were the presence of a transmural anterior myocardial infarction (p less than 0.0005) and the need for preoperative intra-aortic balloon pumping for angina or congestive heart failure (p = 0.009). All perioperative mortalities (12 patients) occurred in this subset (anterior myocardial infarction, intra-aortic balloon pumping, or both) that included 101 patients. The mean follow-up period was 27.8 months (range, 1-69 months). There were 11 late deaths, resulting in an actuarial survival of 92 +/- 2%, 91 +/- 2%, 88 +/- 2.6%, and 88 +/- 4% at 1,2,3, and 4 years, respectively. Ninety-six percent of survivors were assigned to New York Heart Association Class I or II for congestive heart failure, and 96% were assigned to Class I or II for angina. Urgent coronary artery bypass grafting can be performed in patients with unstable postinfarction angina with acceptable mortality, although a significant increase in risk exists for patients with preoperative transmural anterior myocardial infarction, intra-aortic balloon pumping, or both.
Stuart
R S
RS
Division of Cardiac Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Baumgartner
W A
WA
Soule
L
L
Borkon
A M
AM
Gardner
T J
TJ
Gott
V L
VL
Watkins
L
L
Reitz
B A
BA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000601:surgery*; D000789:Angina, Unstable / Q000401:mortality / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D012307:Risk Factors