Coronary artery bypass for recent infarction. Predictors of mortality.
The role of coronary artery bypass (CAB) surgery in patients with recent myocardial infarction remains controversial. To more clearly define the operative risks, we reviewed 336 patients who underwent isolated CAB within 30 days of infarction. There were 129 patients with stable or no angina (Group 1), 163 with angina at rest (Group 2), 21 with angina requiring intra-aortic balloon counterpulsation for pain control (Group 3), and 23 with severe postinfarction ischemia or extension complicated by cardiogenic shock (Group 4). There were 26 (7.7%) deaths overall. The mortality was 2.3% in Group 1, 6.1% in Group 2, 9.5% in Group 3, and 47.8% in Group 4. Univariate analysis (Student's t and chi 2 tests) and multivariate analysis (stepwise logistic regression model) were performed on 17 variables: age, gender, clinical Group (1-4), number of diseased vessels, presence of left main artery disease, left ventricular wall-motion score, left ventricular end-diastolic pressure, presence of mitral insufficiency, extent of infarction (subendocardial vs. transmural), interval from infarction to CAB, number of distal anastomoses performed, preoperative hemodynamic status, aortic cross-clamp time, and total cardiopulmonary bypass time. Only advanced age (p = 0.002), left ventricular wall-motion score (p = 0.004), and clinical group (p = 0.048) proved to be independent predictors of mortality by multivariate analysis.(ABSTRACT TRUNCATED AT 250 WORDS)
Naunheim
K S
KS
Department of Surgery, St. Louis University Medical Center, Missouri.
Kesler
K A
KA
Kanter
K R
KR
Fiore
A C
AC
McBride
L R
LR
Pennington
D G
DG
Barner
H B
HB
Kaiser
G C
GC
Willman
V L
VL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D006321:Heart / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D012307:Risk Factors; D013997:Time Factors