Surgical revascularization of left main coronary artery stenosis: Determinants of perioperative and long-term outcome in the 1980s

Abstract

The postoperative courses of 176 patients who underwent coronary artery bypass surgery for significant left main coronary artery stenosis were analyzed to determine which preoperative clinical and angiographic factors correlated best with outcome. Clinical variables included age, sex, New York Heart Association (NYHA) anginal class, presence of unstable angina, and surgical class. The angiographic variables included percentage of left main stenosis, presence of right coronary artery stenosis, coronary dominance, number of vessels diseased, myocardial jeopardy score, and ejection fraction. The overall perioperative mortality rate was 9.1%. There was a significant increase in perioperative mortality among female patients ( p < 0.05) and patients undergoing emergency surgery ( p < 0.05). Patients with left main stenosis of 80% or more or with balanced or left dominant circulation showed trends toward increased perioperative mortality. Life-table analysis showed that emergency surgery and left main stenosis of 80% or more correlated with increased long-term mortality ( p < 0.05). No other variable tested showed a significant correlation with either perioperative or long-term mortality. A comparison of these results with studies performed in the 1970s shows that there has been considerable change in those factors which place a patient at increased risk for mortality during surgical treatment of left main coronary artery stenosis.