Copyright © 1991 by the European Society of Cardiology.
© 1991 The European Society of Cardiology
Risk Factors for operative mortality and morbidity in patients undergoing coronary artery bypass surgery for stable angina pectoris
*Departments of Thoracic and Cardiovascular Surgery Uppsala, Sweden
Department of Statistics, University of Uppsala Uppsala, Sweden
||Departments of Surgery, University Hospital Uppsala, Sweden
Received 20 September 1989; revised 16 February 1990; .
Correspondence to: Elisabeth St{dot}hle, Department of Thoracic and Cardiovascular Surgery, University Hospital, S-751 85 Uppsala, Sweden.
Abstract
Risk factors for a poor early outcome of surgery for stable angina pectoris were evaluated in 2659 consecutive patients from a defined population.
The total operative mortality (death within 30 days after surgery) was 2.6% and the frequency of myocardial injury (increase in S-ASAT to >2.0µkat l–1 and in S-CKMB to > 1.5 µlat I –1within 48 h postoperatively or death in the operating room) 14%. Mortality was related to New York Heart Association (NYHA) classification (P<0.001), age ( < or >70 years, P = 0.001), duration of symptoms ( < or >8 years, P = 0.001), aortic cross-clamp (ACC) time (P < 0.001), and cardiopulmonary bypass (CBP) time (P < 0.001). A multivariate analysis showed that the combination of NYHA class, ACC time and age best predicted operative mortality. Myocardial injury was related to NYHA functional class (P<0.001), duration of symptoms (P<0.001), regrafting procedure (P<0.001), cardiac related dyspnoea (P = 0.015), ACC time (P = 0.001), CPB time (P = 0.001), relative volume of cardioplegic solution (P<0.001), and thromboendarterectomy procedure (P = 0.004). The set of variables that best predicted myocardial injury consisted of ACC time, relative volume cardioplegic solution, NYHA class, regrafting procedure and duration of symptoms. However, these risk factors indicated only moderately high risks, and high-risk patients could not be selected with sufficient accuracy.
Key Words: Risk assessment • coronary bypass
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