| Recent preoperative myocardial infarction increases the risk of surgery for unstable angina. | |
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MedLine Citation:
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PMID: 1799729 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Patients with postinfarction angina undergoing surgery for unstable angina face an increased risk of operative mortality. Between January 1982 and December 1987, clinical, angiographic, and operative data was collected prospectively in 588 unstable patients with a prior myocardial infarction within 30 days of surgery (MI) and 5951 unstable patients without preoperative damage (NONMI). MI patients were characterized as being older (age greater than or equal to 70 years: MI, 19.7%; NONMI, 11.6%; p less than 0.001) and having more left ventricular dysfunction (left ventricular ejection fraction less than 40%: MI, 34.8%; NONMI, 26.4%; p less than 0.001). Semi-elective surgery was performed in 82.0% of NONMI patients while 76.9% of MI patients underwent urgent surgery. Operative mortality was increased in MI patients (MI, 11.1%; NONMI, 4.0%; p less than 0.001) which was related to the extent of preoperative MI (non-Q wave, 8.3%; Q wave, 17.5%; p less than 0.001). Stepwise logistic regression analysis identified preoperative MI as an independent risk variable of operative mortality for unstable angina. Separate multivariate analyses were performed to identify the independent predictors for MI and NONMI patients. The multivariate predictors of operative death for MI patients were left ventricular dysfunction, reoperative coronary surgery, nonuse of the internal mammary, age, transmural MI (relative risk 2.11 vs non-Q wave infarction) and left main stenosis. For NONMI patients, the independent variables were urgent operation, left ventricular dysfunction, reoperation, female gender, left main stenosis, and age. The results of this study indicate that recent preoperative MI adversely influences the surgical results in patients with unstable angina. Alternative treatment strategies are warranted for high risk patients, particularly those with transmural MIs and impaired ventricular function. |
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Authors:
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S E Fremes; B S Goldman; R D Weisel; J Ivanov; G T Christakis; T A Salerno; T E David |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of cardiac surgery Volume: 6 ISSN: 0886-0440 ISO Abbreviation: J Card Surg Publication Date: 1991 Mar |
Date Detail:
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Created Date: 1992-04-20 Completed Date: 1992-04-20 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8908809 Medline TA: J Card Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 2-12 Citation Subset: IM |
Affiliation:
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Division of Cardiovascular Surgery, University of Toronto, Ontario, Canada. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Angina, Unstable / mortality, surgery* Coronary Artery Bypass / mortality* Female Hospital Mortality Humans Male Middle Aged Myocardial Infarction / epidemiology* Prognosis Regression Analysis Risk Factors Time Factors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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