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. 1978 Jan-Feb;51(1):27–36.

Predictors of Operative Mortality for Coronary Bypass Grafting in Patients with Ischemic Heart Disease

Rene A Langou, John C Wiles, Peter N Peduzzi, Graeme Hammond, Lawrence S Cohen
PMCID: PMC2595643  PMID: 307873

Abstract

Predictors for operative mortality (OM) were studied in 172 consecutive patients (pts) undergoing coronary artery grafts (CAG) for angina pectoris.

Seventy eight pts had Class IV angina; of the 147 patients given propranolol, 41 were gradually withdrawn from propranolol and finally discontinued 24 hours before surgery, and 106 were abruptly withdrawn from propranolol 24 hours before CAG; 20 pts had left main coronary disease; 156 pts had cardiopulmonary bypass (CPB) time shorter than 20 minutes, and 16 pts had a CPB longer than 120 minutes.

The operative mortality was 5.2% (9/172) for the entire group. Class IV angina (OM 7%), abrupt propranolol withdrawal (OM 6.6%), left main coronary artery disease (OM 25%), and CPB longer than 120 minutes (OM 50%), all significantly increased OM. These variables were interdependent, however, as many pts belonged to several predictor categories, combinations of predictors were examined, in order to more accurately predict the risk of individual pts. The combination of left main coronary artery disease and CPB longer than 120 minutes; and Class IV angina and CPB longer than 120 minutes were significantly associated with higher operative mortality.

We conclude that Class IV angina, abrupt propranolol withdrawal, left main coronary artery disease and prolonged CPB are potent, interdependent predictors of OM in pts undergoing CAG. Consideration of these predictors, alone and in combination, allows effective prediction of OM for CAG in patients with stable angina pectoris.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alderman E. L., Coltart D. J., Wettach G. E., Harrison D. C. Coronary artery syndromes after sudden propranolol withdrawal. Ann Intern Med. 1974 Nov;81(5):625–627. doi: 10.7326/0003-4819-81-5-625. [DOI] [PubMed] [Google Scholar]
  2. Anderson R. P., Rahimtoola S. H., Bonchek L. I., Starr A. The prognosis of patients with coronary artery disease after coronary bypass operations. Time-related progress of 532 patients with disabling angina pectoris. Circulation. 1974 Aug;50(2):274–282. doi: 10.1161/01.cir.50.2.274. [DOI] [PubMed] [Google Scholar]
  3. Bartel A. G., Behar V. S., Peter R. H., Orgain E. S., Kong Y. Exercise stress testing in evaluation of aortocoronary bypass surgery. Report of 123 patients. Circulation. 1973 Jul;48(1):141–148. doi: 10.1161/01.cir.48.1.141. [DOI] [PubMed] [Google Scholar]
  4. Bertolasi C. A., Trongé J. E., Carreno C. A., Jalon J., Vega M. R. Unstable angina--prospective and randomized study of its evolution, with and without surgery. Am J Cardiol. 1974 Feb;33(2):201–208. doi: 10.1016/0002-9149(74)90275-6. [DOI] [PubMed] [Google Scholar]
  5. Cannom D. S., Miller D. C., Shumway N. E., Fogarty T. J., Daily P. O., Hu M., Brown B., Jr, Harrison D. C. The long-term follow-up of patients undergoing saphenous vein bypass surgery. Circulation. 1974 Jan;49(1):77–85. doi: 10.1161/01.cir.49.1.77. [DOI] [PubMed] [Google Scholar]
  6. Cohen M. V., Gorlin R. Main left coronary artery disease. Clinical experience from 1964-1974. Circulation. 1975 Aug;52(2):275–285. doi: 10.1161/01.cir.52.2.275. [DOI] [PubMed] [Google Scholar]
  7. Coltart D. J., Cayen M. N., Stinson E. B., Goldman R. H., Davies R. O., Harrison D. C. Investigation of the safe withdrawal period for propranolol in patients scheduled for open heart surgery. Br Heart J. 1975 Dec;37(12):1228–1234. doi: 10.1136/hrt.37.12.1228. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cooley D. A., Dawson J. T., Hallman G. L., Sandiford F. M., Wukasch D. C., Garcia E., Hall R. J. Aortocoronary saphenous vein bypass. Results in 1,492 patients, with particular reference to patients with complicating features. Ann Thorac Surg. 1973 Oct;16(4):380–390. doi: 10.1016/s0003-4975(10)65009-6. [DOI] [PubMed] [Google Scholar]
  9. DeMots H., Bonchek L. I., Rösch J., Anderson R. P., Starr A., Rahimtoola S. H. Left main coronary artery disease. Risks of angiography, importance of coexisting disease of other coronary arteries and effects of revascularization. Am J Cardiol. 1975 Aug;36(2):136–141. doi: 10.1016/0002-9149(75)90516-0. [DOI] [PubMed] [Google Scholar]
  10. Diaz R. G., Somberg J., Freeman E., Levitt B. Myocardial infarction after propranolol withdrawal. Am Heart J. 1974 Aug;88(2):257–258. doi: 10.1016/0002-8703(74)90019-2. [DOI] [PubMed] [Google Scholar]
  11. Geha A. S., Krone R. J., McCormick J. R., Baue A. E. Selection of coronary bypass. Anatomic, physiological, and angiographic considerations of vein and mammary artery grafts. J Thorac Cardiovasc Surg. 1975 Sep;70(3):414–431. [PubMed] [Google Scholar]
  12. Green G. E. Internal mammary artery-to-coronary artery anastomosis. Three-year experience with 165 patients. Ann Thorac Surg. 1972 Sep;14(3):260–271. doi: 10.1016/s0003-4975(10)65228-9. [DOI] [PubMed] [Google Scholar]
  13. Greene D. G., Carlisle R., Grant C., Bunnell I. L. Estimation of left ventricular volume by one-plane cineangiography. Circulation. 1967 Jan;35(1):61–69. doi: 10.1161/01.cir.35.1.61. [DOI] [PubMed] [Google Scholar]
  14. Hammond G. L., Poirier R. A. Early and late results of direct coronary reconstructive surgery for angina. J Thorac Cardiovasc Surg. 1973 Jan;65(1):127–133. [PubMed] [Google Scholar]
  15. Hutchinson J. E., 3rd, Green G. E., Mekhjian H. A., Gallozzi E., Cameron A., Kemp H. G. Coronary bypass grafting in 476 patients consecutively operated on. Chest. 1973 Dec;64(6):706–710. doi: 10.1378/chest.64.6.706. [DOI] [PubMed] [Google Scholar]
  16. Kaiser G. C., Barner H. B., Willman V. L., Mudd J. G., Westura E. W., Alves L. E. Aortocoronary bypass grafting. Arch Surg. 1972 Aug;105(2):319–323. doi: 10.1001/archsurg.1972.04180080167028. [DOI] [PubMed] [Google Scholar]
  17. Manley J. C., King J. F., Zeft H. J., Johnson W. D. The "bad" left ventricle. Results of coronary surgery and effect on late survival. J Thorac Cardiovasc Surg. 1976 Dec;72(6):841–848. [PubMed] [Google Scholar]
  18. McNeer J. F., Starmer C. F., Bartel A. G., Behar V. S., Kong Y., Peter R. H., Rosati R. A. The nature of treatment selection in coronary artery disease. Experience with medical and surgical treatment of a chronic disease. Circulation. 1974 Apr;49(4):606–614. doi: 10.1161/01.cir.49.4.606. [DOI] [PubMed] [Google Scholar]
  19. Morris G. C., Jr, Reul G. J., Howell J. F., Crawford E. S., Chapman D. W., Beazley H. L., Winters W. L., Peterson P. K., Lewis J. M. Follow-up results of distal coronary artery bypass for ischemic heart disease. Am J Cardiol. 1972 Feb;29(2):180–185. doi: 10.1016/0002-9149(72)90627-3. [DOI] [PubMed] [Google Scholar]
  20. Najmi M., Ushiyama K., Blanco G., Adam A., Segal B. L. Results of aortocoronary artery saphenous vein bypass surgery for ischemic heart disease. Am J Cardiol. 1974 Jan;33(1):42–48. doi: 10.1016/0002-9149(74)90738-3. [DOI] [PubMed] [Google Scholar]
  21. Oldham H. N., Jr, Kong Y., Bartel A. G., Morris J. J., Jr, Behar V. S., Peter R. H., Rosati R. A., Young W. G., Jr, Sabiston D. C., Jr Risk factors in coronary artery bypass surgery. Arch Surg. 1972 Dec;105(6):918–923. doi: 10.1001/archsurg.1972.04180120095018. [DOI] [PubMed] [Google Scholar]
  22. Scanlon P. J., Nemickas R., Moran J. F., Talano J. V., Amirparviz F., Pifarre R. Accelerated angina pectoris. Clinical, hemodynamic, arteriographic, and therapeutic experience in 85 patients. Circulation. 1973 Jan;47(1):19–26. doi: 10.1161/01.cir.47.1.19. [DOI] [PubMed] [Google Scholar]
  23. Sheldon W. C., Rincon G., Pichard A. D., Razavi M., Cheanvechai C., Loop F. D. Surgical treatment of coronary artery disease: pure graft operations, with a study of 741 patients followed 3--7 yr. Prog Cardiovasc Dis. 1975 Nov-Dec;18(3):237–253. doi: 10.1016/0033-0620(75)90013-4. [DOI] [PubMed] [Google Scholar]
  24. Slome R. Withdrawal of propranolol and myocardial infarction. Lancet. 1973 Jan 20;1(7795):156–156. doi: 10.1016/s0140-6736(73)90235-3. [DOI] [PubMed] [Google Scholar]
  25. Viljoen J. F., Estafanous F. G., Kellner G. A. Propranolol and cardiac surgery. J Thorac Cardiovasc Surg. 1972 Nov;64(5):826–830. [PubMed] [Google Scholar]
  26. Zeft H. J., Manley J. C., Huston J. H., Tector A. J., Auer J. E., Johnson W. D. Left main coronary artery stenosis; results of coronary bypass surgery. Circulation. 1974 Jan;49(1):68–76. doi: 10.1161/01.cir.49.1.68. [DOI] [PubMed] [Google Scholar]

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