Document Detail


Assessing the risk of waiting for coronary artery bypass graft surgery among patients with stenosis of the left main coronary artery.
MedLine Citation:
PMID:  16103509     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Significant controversy remains over how urgently coronary artery bypass graft surgery (CABG) should be scheduled, particularly for patients with stenosis of the left main coronary artery. Our main objective was to evaluate the safety of waiting for CABG among patients with left main coronary artery disease using a standardized triage system. METHODS: We identified 561 consecutive patients with stenosis of the left main coronary artery who were scheduled to undergo CABG between Apr. 1, 1999, and Mar. 31, 2003. Using standardized triage criteria, patients were assigned to 1 of 4 waiting queues: "emergent," "in-hospital urgent," "out-of-hospital semi-urgent A" and "out-of-hospital semi-urgent B." Postoperative outcome measures were in-hospital death from any cause and a composite outcome measure of in-hospital death from any cause, a prolonged requirement for postoperative mechanical ventilation (> 24 h) and a prolonged postoperative hospital stay (> 9 d). Waiting-time variables included the specific queue, whether patients waited longer than the standard time established for each queue and whether patients were upgraded to a more urgent queue. Logistic regression analysis was used to identify independent predictors of the composite outcome; propensity scores (probability of being assigned to a specific queue) were entered into the model to adjust for patient variability among queues. RESULTS: Of the 561 patients, 65 (11.6%) were assigned to the emergent group, 343 (61.1%) to the in-hospital urgent group, 91 (16.2%) to the semi-urgent A queue and 62 (11.1%) to the semi-urgent B queue. Four patients (0.7%) died while waiting for surgery. The median waiting times were as follows: emergent group, 0 days; in-hospital urgent group, 2 days; 30 days in the semi-urgent A group and 49 days in the semi-urgent B group. A total of 52 patients (9.3%) were upgraded to a more urgent queue, and 147 patients (26.2%) waited longer than the standard times for their respective queue. The overall in-hospital mortality was 5.5% (n = 31), and the composite outcome was 32.6% (n = 183). Independent predictors of the composite outcome were myocardial infarction within 7 days before surgery, preoperative renal failure, ejection fraction of less than 40%, age greater than 70 years and stenosis of left main coronary artery greater than 70%. Waiting-time variables were associated with neither a significantly higher mortality nor morbidity outcome. INTERPRETATION: For selected patients with stenosis of the left main coronary artery, waiting for CABG did not appear to be associated with increased mortality or morbidity.
Authors:
Jean-François Légaré; Alex MacLean; Karen J Buth; John A Sullivan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne     Volume:  173     ISSN:  1488-2329     ISO Abbreviation:  CMAJ     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-08-16     Completed Date:  2005-10-21     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  9711805     Medline TA:  CMAJ     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  371-5     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, NS. jean.legare@cdha.nshealth.ca
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Cohort Studies
Coronary Artery Bypass*
Coronary Stenosis / mortality,  pathology,  surgery*
Female
Humans
Length of Stay
Male
Prognosis
Respiration, Artificial
Retrospective Studies
Risk Factors
Safety
Survival Analysis
Time Factors
Treatment Outcome
Triage*
Comments/Corrections
Comment In:
CMAJ. 2005 Aug 16;173(4):381-2   [PMID:  16103511 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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