Main clinical and surgical determinants of in-hospital mortality after surgical revascularization of left main coronary artery stenosis: 2 year retrospective study (1998-1999)
Abstrakt
Stenosis of left main coronary artery (LMCA) is a common finding on coronary angiographies (7 to 10%). Mortality is very high for conservative therapy in comparison with surgery, which provides very good long-term outcome and is accepted as the standard therapy of this condition. Over the last few years, percutaneous coronary intervention (PCI) has become a new alternative in selected patients.
Aim of the study: To assess in hospital mortality in subjects referred to our surgical unit for coronary artery bypass grafting (CABG) and to identify the main clinical and surgical determinants of in-hospital mortality.
Methods: Two year retrospective analysis (1998-1999) of in-hospital mortality and morbidity of patients having left main stenosis referred for CABG.
Results: Among a group of 1443 patients operated for coronary heart disease, LMCA stenosis was found in 330 patients (22.9 %). The mean age was 63 ± 8.6 years. Elective surgery was done in 173 patients (52.4 %), and acute operation (i.e. urgent, emergent or desperate) in 157 patients (47.6 %). The total in-hospital mortality was 4.2 % (14/330). Elective surgery in-hospital mortality was 1.7 % (3/173) and urgent surgery in-hospital mortality was 7 % (11/157). The main risk factors of in-hospital mortality were age > 68 years, low ejection fraction (LVEF < 0.4), history of myocardial infarction, gender (female) and urgency of the operation.
Conclusion: The proportion of patients undergoing CABG for left main stenosis is relatively high in our center and their mortality is quite low especially for elective operations. As the mortality of patients treated by PCI for LMCA stenosis is similar to surgery in high-risk patients, we postulate that this approach can be a real alternative treatment for such patients. Because of its potential benefit, combined revascularisation is also an alternative that should be considered in some cases. Furthermore, as a new generation of coated stents has emerged in the treatment of restenosis after PCI, we hypothesize that this method can in the near future be accepted as equivalent to surgery. However several randomized clinical trials must first be conduced prove this point.