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Early and late survival after coronary‐artery surgery
Author(s) -
Rowe Michael H.,
Mullany Charles J.,
White Antoinette L.,
Wilson Anthony C.,
Clarebrough John K.
Publication year - 1989
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1989.tb136761.x
Subject(s) - medicine , cardiology , myocardial infarction , coronary care unit , artery , survival rate , diabetes mellitus , mortality rate , stenosis , aneurysm , surgery , endocrinology
Between 1970 and 1985, 1801 patients underwent coronary‐artery surgery without associated valvular surgery. Eighty‐four per cent of patients were male and the mean (±SD) age was 55.7±8.3 years. Of the patients, 18.7% were from the Coronary Care Unit and 6.5% had diabetes. The hospital mortality rate for the whole group was 3.5%. Patients from the Coronary Care Unit had the highest (8.9%) hospital mortality rate compared with those patients who were not from the Coronary Care Unit (2.1%; P < 0.001). Other factors which increased the hospital mortality rate significantly were the number of diseased vessels ( P < 0.01), the degree of left main coronary‐artery stenosis ( P < 0.001), an earlier year of surgery ( P < 0.01) and female sex ( P < 0.01). After these were taken into account, no other factors (for example, age, preoperative infarction, presence of left‐ventricular aneurysm, left‐ventricular end‐diastolic pressure, diabetes, use of mammary‐arterial grafts or the need for endarterectomy) affected the mortality rate. Patients were followed‐up for a mean (±SD) of 4.4 ±2.8 years. The five‐year survival rate for all patients was 88% and the 10‐year survival rate was 65%. Cox regression analysis showed that the significant indicators of decreased long‐term survival were undergoing operation directly from the Coronary Care Unit ( P < 0.001), left main coronary‐artery stenosis ( P < 0.01), the number of grafted vessels ( P < 0.01), concomitant surgery for aneurysm ( P < 0.001), year of surgery ( P < 0.01) and age ( P < 0.01). Seventy‐nine per cent of patients were free of angina pectoris at five years after operation. The year of surgery ( P < 0.001) and preoperative myocardial infarction ( P < 0.05) were the best predictors of recurrent angina. In the long term, recurrent angina remains a problem, although this may change with the increased use of mammary‐arterial grafts. (Med J Aust 1989; 150: 682‐693)