Aortocoronary artery bypass: present indications and risk factors
G. J. Reul Jr, D. A. Cooley, F. M. Sandiford, E. R. Kyger 3rd, D. C. Wukasch and G. L. Hallman
From 1969 through 1974, a total of 4,522 patients were operated on for
coronary artery occlusive disease. This article is an in-depth analysis of
a consecutive series of 275 of these patients, operated on during 1974. The
mortality was 1.8% and perioperative myocardial infarction occurred in
3.6%. On analysis of risk factors, it was found that 24% of the patients
were over the age of 60; 57% had some degree of left ventricular
dysfunction; 9% had generalized hypokinesis; 24% were New York Heart
Association functional class IV; 13% had left main coronary artery
stenosis; and 11% had preinfarction angina. On analysis of the early
mortality, the limiting factor was diffuse coronary arteriosclerosis
combined with poor ventricular function. This resulted in inadequate or
incomplete myocardial revascularization. Since these two risk factors are
usually predictable, coronary artery bypass can be recommended not only for
patients with intractable angina, but also for patients with impaired left
ventricular function associated with angina, and in patients without angina
who have a positive stress electrocardiogram.
