title: High mortality associated with precluded coronary artery bypass surgery caused by severe distal coronary artery disease.
abstract: BACKGROUND
  Patients with extensive coronary artery disease (CAD) have better prognosis when treated with coronary artery bypass grafting surgery (CABG), especially when left ventricular dysfunction (LVD) is present. However, there are scanty data about the clinical course of patients not referred to CABG because of extensive and severe atherosclerotic involvement of distal coronary arteries (ENDCAD). The aim of this study was to evaluate patients with multivessel (MV) or left main CAD (LM) who had CABG precluded because of ENDCAD.
  
  
  RESULTS
  Between August 1999 and July 2001, 51 patients who had clinical indication but were not eligible for CABG because of ENDCAD were followed for at least 12 months or until death. There were 32 men and 19 women (age 61+/-9 years). Previous acute myocardial infarction (AMI) was present in 31 (60.8%), diabetes mellitus (DM) in 28 (54.9%), systemic arterial hypertension in 37 (72.5%), LVD (left ventricular ejection fraction <40%) in 26 (51%), 3 vessel CAD in 31 (60.8%), and LM in 4 (7.8%). During follow-up there were 20 cardiac (39.2%) deaths, 19 (37.2%) AMI, and 3 (5.8%) patients developed congestive heart failure. There were 2 (3.9%) noncardiac deaths. Patients with DM (60.7% versus 13%; P=0.001; odds ratio [OR], 10.30; 95% confidence interval [CI], 2.46 to 43.09), LVD (76.9% versus 0%; P<0.0001; OR, 4.33; 95% CI, 2.14 to 8.74), 3-vessel CAD (51.6% versus 20%; P=0.039; OR, 4.26; 95% CI, 1.16 to 15.69), and LM (100% versus 34%; P=0.019; OR, 1.25; 95% CI, 1.004 to 1.556) were more likely to die. There was no deaths in patients with 2-vessel CAD but they had more nonfatal AMI (43.8% versus 14.3%; OR, 4.667; 95% CI, 1.188 to 18.332).
  
  
  CONCLUSIONS
  Patients in whom CABG could not be performed because of ENDCAD had high mortality, especially in the presence of LVD. DM (particularly insulin-dependent), LM CAD, and 3-vessel CAD were independent markers of increased risk.
authors.affiliation: Department of Coronary Artery Disease and Cardiac Surgery of Adults, Instituto Nacional de Cardiologia Laranjeiras, Ministério da Saúde, Rio de Janeiro, Brazil. ascrbr@centroin.com.br
authors.forename: Antônio Sérgio Cordeiro da
authors.initials: AS
authors.lastname: Rocha
authors.forename: Nella Paula Rodrigues
authors.initials: NP
authors.lastname: Dassa
authors.forename: Felipe José Monassa
authors.initials: FJ
authors.lastname: Pittella
authors.forename: Odilon Nogueira
authors.initials: ON
authors.lastname: Barbosa
authors.forename: José Oscar Reis
authors.initials: JO
authors.lastname: Brito
authors.forename: Bernardo
authors.initials: B
authors.lastname: Tura
authors.forename: Paulo Roberto Dutra da
authors.initials: PR
authors.lastname: Silva
mesh_terms: D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002423:Cause of Death; D015897:Comorbidity; D000075202:Contraindications; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy; D048909:Diabetes Complications / Q000401:mortality; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology
chemical_list: D002317:Cardiovascular Agents