Myocardial revascularization with coronary endarterectomy. Stratification of risk factors for early mortality

Arq Bras Cardiol. 2000 Oct;75(4):269-80. doi: 10.1590/s0066-782x2000001000002.

Abstract

Objective: To determine the risk factors for mortality related to myocardial revascularization when performed in association with coronary endarterectomy.

Methods: We assessed retrospectively 353 patients who underwent 373 coronary endarterectomies between January '89 and November '98, representing 3.73% of the myocardial revascularizations in this period of time. The arteries involved were as follows: right coronary artery in 218 patients (58.45%); left anterior descending in 102 patients (27.35%); circumflex artery in 39 patients (10.46%); and diagonal artery in 14 patients (3.74%). We used 320 (85.79%) venous grafts and 53 (14.21%) arterial grafts.

Results: In-hospital mortality among our patients was 9.3% as compared with 5.7% in patients with myocardial revascularizations without endarterectomy (p=0.003). Cause of death was related to acute myocardial infarction in 18 (54.55%) patients. The most significant risk factors for mortality identified were as follows: diabetes mellitus (p=0.001; odds ratio =7.168), left main disease (<0.001; 9.283), female sex (0.01; 3.111), acute myocardial infarction (0.02; 3.546), ejection fraction <35% (<0.001; 5.89), and previous myocardial revascularization (<0.001; 4.295).

Conclusion: Coronary endarterectomy is related to higher mortality, and the risk factors involved are important elements of a poor outcome.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arrhythmias, Cardiac / mortality
  • Cause of Death
  • Coronary Vessels / surgery*
  • Endarterectomy / methods
  • Endarterectomy / mortality*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / mortality
  • Myocardial Revascularization / methods
  • Myocardial Revascularization / mortality*
  • Postoperative Period
  • Retrospective Studies
  • Risk Factors
  • Shock, Cardiogenic / mortality