Clinical factors influencing survival and adequacy of revascularization after coronary bypass operation

Abstract

We retrospectively analyzed the clinical data on 3479 consecutive patients having coronary bypass surgery. Patients with triple vessel and left main coronary disease had a greater frequency of inotropic requirements than did patients with single or double vessel disease (7.9% and 8.6% versus 3.8% and 4.2%; P < 0.001). Presence of previous myocardial infarction, heart failure, or left ventricular contraction abnormalities significantly decreased the ability to achieve complete revascularization with bypass grafting. Hospital mortality since 1976 has been 0.8% ( 25 3040 ). Hospital mortality was significantly increased by history of myocardial infarction ( P < 0.001), hypertension ( P < 0.05), heart failure ( P < 0.01), extent of anatomic disease ( P < 0.005), presence of preoperative ST-T wave changes ( P < 0.001), and severe abnormalities of left ventricular function ( P < 0.001). Anginal pattern, history of hypertension, previous myocardial infarction, preoperative heart failure but not perioperative myocardial infarction significantly affected long-term survival. Patients with normal left ventricular function had excellent 42-month survival regardless of vessel disease. Inability to achieve complete revascularization did not adversely affect hospital mortality, but did significantly reduce late survival. Although bypass grafting improves survival in patients with multivessel disease and left ventricular dysfunction, the benefits appear to be significantly reduced when left ventricular damage has occurred.