The risk of early mortality and low-output syndrome needing intra-aortic balloon support tended to be higher in women compared with men. Women did not run an increased risk of total mortality, recurrent angina or of total non-fatal myocardial infarction. The standard mortality ratio was increased in both men and women, but in particular higher in women, suggesting a more aggressive course of coronary artery disease in operated women than in operated men. However, this difference did not show in the long term follow-up, due to the beneficial effect of coronary artery bypass surgery in both men and women.
Of 1025 patients (912 men, 113 women) who underwent coronary artery bypass grafting and were followed up for a mean of 7.4 years, 45 (4.4%) had diabetes mellitus. Norwegian population is 1.8-2%). Early mortality was not significantly greater among diabetics than in non-diabetics (2.2 vs. 3.1%, odds ratio--OR-0.44, confidence interval--CI- 0.05-3.56). Diabetic patients had no increased risk of perioperative myocardial infarction (OR = 0.87, CI 0.36-2.10) or of low-output syndrome necessitating intraortic balloon pumping (OR = 0.42, CI 0.55-3.05), and no excess incidence of late non-fatal myocardial infarction (relative risk = 0.69, CI 0.10-1.28) or late chronic heart failure (OR = 2.50, CI 0.5-11.0). Long-term mortality was increased in the diabetic patients (relative risk 1.87, CI 1.60-2.14). Thus diabetes did not entail heightened risk of early mortality, perioperative myocardial infarction or low-output syndrome. Nor was there excess risk of recurrent angina pectoris, late non-fatal myocardial infarction or chronic heart failure among the diabetic patients, but the late mortality risk was increased.
The low osmolar nonionic contrast medium Omnipaque was used in 5,339 consecutive coronary angiographies and serious complications were registered. Myocardial infarction occurred in 4 patients, of whom 2 died, and ventricular fibrillation in 1. Cerebral embolism occurred in 11 patients, all of whom survived. The results are compared with those of previous series of coronary angiography with high osmolar ionic media. It is concluded that use of the nonionic medium Omnipaque resulted in a significant reduction of the frequency of serious complications.
The long-term results of 1025 patients, 912 men and 113 women, undergoing coronary artery bypass grafting (CABG) at the Cardiovascular Unit of Rikshospitalet, Oslo, between 1982 and 1986, were analyzed on factors associated with the return of angina pectoris and of non-fatal post CABG myocardial infarction. The closing date was 1st January 1993, with a mean follow-up time of 7.4 years. Recurrent angina pectoris was experienced by 118 (11.6%) patients and 102 (10%) patients experienced non-fatal post CABG myocardial infarction during the observation period. Altogether 30 possible risk factors were analyzed. The cumulative incidence of recurrent angina was initially low after operation, followed by a rise after 4 years. One, 5 and 10 years after the operation, survival free from angina rates were 97.8%, 91.8% and 80.6%, respectively. The cumulative incidence of post CABG myocardial infarction was also low initially, followed by a rise after 4 years. The survival free of non-fatal post CABG myocardial infarction rate was 98.9%, 96% and 83.5%, at 1, 5 and 10 years after surgery, respectively. The incremental risk factor of recurrent angina pectoris was hypertension. The independent risk factors of non-fatal post CABG myocardial infarction were hypertension and preoperative stenosis of the left-sided, versus right-sided, coronary arteries. The study emphasizes the favorable effect of coronary bypass surgery on the functional outcome in patients with symptomatic coronary artery disease.
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