The role of coronary artery bypass (CAB) surgery in patients with recent myocardial infarction remains controversial. To more clearly define the operative risks, we reviewed 336 patients who underwent isolated CAB within 30 days of infarction. There were 129 patients with stable or no angina (Group 1), 163 with angina at rest (Group 2), 21 with angina requiring intra-aortic balloon counterpulsation for pain control (Group 3), and 23 with severe postinfarction ischemia or extension complicated by cardiogenic shock (Group 4). There were 26 (7.7%) deaths overall. The mortality was 2.3% in Group I, 6.1% in Group 2, 9.5% in Group 3, and 47.8% in Group 4. Univariate analysis (Student's t and χ2 tests) and multivariate analysis (stepwise logistic regression model) were performed on 17 variables: age, gender, clinical Group (1-4), number of diseased vessels, presence of left main artery disease, left ventricular wall-motion score, left ventricular end-diastolic pressure, presence of mitral insufficiency, extent of infarction (subendocardial vs. transmural), interval from infarction to CAB, number of distal anastomoses performed, preoperative hemodynamic status, aortic cross-clamp time, and total cardiopulmonary bypass time. Only advanced age (p = 0.002), left ventricular wall-motion score (p = 0.004), and clinical group (p = 0.048) proved to be independent predictors of mortality by multivariate analysis. These data suggest that 1) early postinfarction CAB may be performed in the stable patient at any time, with a mortality (2%) similar to that of elective CAB; 2) elderly patients or those with poor left ventricular function have a significantly higher mortality; and 3) postinfarction ischemia or infarct extension that results in cardiogenic shock is associated with an extremely high operative mortality.
|Original language||English (US)|
|Issue number||3 II SUPPL.|
|State||Published - Jan 1 1988|
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)