[Comorbidity in surgical myocardial revascularization: risk factors or contraindications for surgery].
BACKGROUND
The worsening evolution of patients undergoing surgical myocardial revascularization makes it difficult the stratification of the preoperative mortality risk, a correct evaluation of results and the comparison of results of different centers. The aim of the study was to evaluate the prognostic weight of comorbidity in surgical myocardial revascularization.


METHODS
We evaluated the characteristics of preoperative morbidity in 4999 patients who underwent surgical myocardial revascularization during four different periods (1979-1980, 1991-1992, 1994-1998, 1999-2002). We also evaluated the in-hospital results.


RESULTS
By comparing the four different periods, an increase in older age, female sex, comorbidity, three-vessel disease, and severe left ventricular dysfunction was observed. Surgical mortality decreased to 2.3%. Multivariate analysis of the 1999-2002 period showed that only renal insufficiency was a risk factor for in-hospital mortality.


CONCLUSIONS
Although the preoperative risk is higher, nowadays hospital mortality is reduced thanks to new cardiac-surgical techniques and approaches that increasing the capacity of controlling comorbidity in the pre-, intra- and postoperative course. For a correct decision-making process it is crucial to assess how much comorbidity may influence the long-term follow-up in these patients independently of surgical myocardial revascularization.
Colombo
Tiziano
T
U. O. di Cardiochirurgia, Dipartimento Cardio-Toraco-Vascolare "A. De Gasperis", A.O. Niguarda Ca' Granda, Milano.
Pelenghi
Stefano
S
Bruschi
Giuseppe
G
Tarelli
Giuseppe
G
Montorsi
Emanuela
E
Merli
Mario
M
Vitali
Ettore
E
D000368:Aged; D000075202:Contraindications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors