title: Urgent surgical revascularization of unstable angina. Influence of double mammary arteries.
abstract: OBJECTIVE
  Aim of this study was to evaluate retrospectively: (1) the outcome in patients with unstable angina (UA) refractory to the medical therapy undergoing urgent-emergent CABG; (2) the influence of both IMAs employment.
  
  
  METHODS
  Between January 1995 and July 2000, 576 (28.5%) consecutive patients with UA underwent CABG procedure. 182 (31.6%, Group I) patients, presenting unstable hemodynamic or angina pectoris refractory to the maximal medical therapy, underwent urgent/emergent CABG. 397 (68.4%, Group II) patients, after the maximal medical therapy did not present angina's episodes or ECG alterations and underwent elective CABG procedure. Preoperative data were similar in the two groups. Both IMAs were used in 68 (37.4%) patients of I and 152 (38%) of II (P>0.05) to left side revascularization.
  
  
  RESULTS
  CAD extension was greater in Group I: 45 (24.7%) patients presented ischemia in >1 area vs 53 (13.5%) in II (P<0.001). Incidence of anteroseptal ischemia resulted significantly higher in I (P=0.017); left main coronary artery stenosis was present in 68 (37%) patients in I vs 108 (27%) in II (P=0.01). LV function resulted significantly depressed in I, demonstrated by a significantly lower LVEF (P<0.001), higher NYHA class (P<0.001) and preoperative incidence of IABP (P<0.001). Intraoperative data analysis did not reveal any difference between groups. Hospital mortality was 13 (7%) and 21 (5.3%) patients in I and II respectively (P=ns). Multivariate analysis of all preoperative and intraoperative variables revealed the age >65 years (P=0.01), congestive heart failure (P<0.001), LVEF<35% (P=0.03), >1 ischemic area (P=0.02) as strong predictors for poor overall survival, and LIMA (P=0.006) and both IMAs (P=0.001) as strong predictors for good overall survival. Actuarial survival at 1, 3 and 5 years resulted to be 98.5, 96.5 and 90% in I and 99, 96 and 92% in II (P=ns).
  
  
  CONCLUSIONS
  CABG has been associated with acceptable outcome in patients with UA which should be applied soonest possible in patients refractory to medical treatment. Total coronary revascularization and employment of both IMAs for left myocardial side are associated with low operative risk and incidence of complications, permit to have acceptable short and long-term outcome in this pool of patients.
authors.affiliation: Department of Cardiac Surgery, University of Florence, 50134 Careggi, Florence, Italy. mbonacchi@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Bonacchi
authors.forename: E
authors.initials: E
authors.lastname: Prifti
authors.forename: G
authors.initials: G
authors.lastname: Giunti
authors.forename: G
authors.initials: G
authors.lastname: Frati
authors.forename: G
authors.initials: G
authors.lastname: Sani
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000401:mortality / Q000601:surgery*; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery; D023921:Coronary Stenosis / Q000401:mortality / Q000601:surgery; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D016019:Survival Analysis