Clinical and angiographic predictors of operative mortality from the collaborative study in coronary artery surgery (CASS).

Abstract

SUMMARY Fifteen institutions participating in the Collaborative Study in Coronary Artery Surgery (CASS) have performed isolated coronary artery bypass surgery upon 6630 patients (1061 women and 5569 men) for coronary artery disease. The overall operative mortality (OM) was 2.3% (range 0.3-6.4%). Mortality increased with age, from 0 in the group 20-29 years old to 7.9% In the group 70 years and older. OM was higher for women in each age group, ranging from 2.8% for ages 30-39 years to 12.3% for age 70 years and older (0.8% and 5.8% for men). Clinical manifestations of congestive heart failure were associated with increased OM. Mortality was 1.4% in one-vessel, 2.1% in two-vessel and 2.8% in three-vessel disease (diameter narrowing > 70%). Among 1019 patients with left main coronary artery (LMCA) stenosis, OM ranged from 1.6% in patients with mild stenosis and a right-dominant system to 25% in patients with severe (. 90%) stenosis and left dominance. OM varied with ejection fraction (EF) (1.9% for EF 50% to 6.7% for EF < 19%) and left ventricular wall motion score (1.7% for least abnormal to 9.1% for most abnormal). For elective surgery, OM was 1.7%, for urgent surgery 3.5%, and for emergency surgery 10.8%. Mortality was 40.0% among 30 patients with severe LMCA stenosis who underwent emergency revascularization. Advanced age, female sex, symptoms of heart failure, LMCA stenosis, impaired left ventricular function and nonelective surgery are associated with a higher OM. These factors should be considered in the selection of patients for coronary artery surgery.

Forecasting coronary heart disease incidence, mortality, and cost: the Coronary Heart Disease Policy Model.

“…Estimates for ages [45][46][47][48][49][50][51][52][53][54] were based on an average of the Minnesota data for 1970 and 1980, adjusted for first MI. The sex-specific case fatality rates for ages [35][36][37][38][39][40][41][42][43][44] were assumed to be equal to the adjusted Minnesota rates for ages 45- persons routinely referred for CABG may be at greater risk than their medically treated counterparts, in contrast to randomized trials in which the patients in both groups are drawn from the same population. The probability that a cardiac arrest will be accompanied by MI in a given year was estimated as in the Bridge Model.…”

Avaliação de uma escala de risco em pacientes submetidos à cirurgia de revascularização do miocárdio: análise de 400 casos

“…Estes fatores são necessariamente restritos aos resultados pré-operatórios e não podem incluir parâme-tros peri e pós-operatórios 25 . Baseando-se na definição descrita, a partir de 1980 teve início o desenvolvimento de escalas de risco que visavam sobretudo a avaliação da mortalidade operatória 10,[26][27][28][29][30] . Dentre os parâmetros mais comuns para análise do pré-operatório, encontram-se a idade [31][32][33][34][35][36] , o sexo 11,37-40 , a função do VE [41][42][43][44] , as doenças co-mórbidas 45,46 , a angiografia coronária com aterosclerose proximal ou distal 47,48 .…”

The heart failure challenge: Optimizing medical and surgical management

“…Observational studies have shown that patients with LV dysfunction who are undergoing CABG have a higher perioperative and long-term mortality than patients with normal LV function (15)(16)(17)(18). The presence of comorbid conditions also contributes significantly to higher perioperative mortality.…”