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Ann Thorac Surg 1986;41:42-50
© 1986 The Society of Thoracic Surgeons
David Fray, principal investigators of CASS and their associates Presented at the Twenty-first Annual Meeting of The Society of Thoracic Surgeons, Phoenix, AZ, Jan 21–23, 1985
* Address reprint requests to Dr. Foster, ME 622, Albany Medical College, Albany, NY 12208
It has been suggested that coronary artery bypass grafting (CABG) is efficacious in patients with severe coronary artery disease before they undergo a major noncardiac operation. The Coronary Artery Surgery Study (CASS) registry population was reviewed to identify variables affecting operative mortality and cardiovascular morbidity for noncardiac procedures, and to assess the influence of prior CABG on these surgical risks.
Major noncardiac operations were performed on 1,600 registry patients between June 30, 1978, and June 30, 1981. Operative mortality for individuals without significant coronary artery disease (Group 1) was 0.5% (2/399) and for patients with such disease having CABG prior to a noncardiac procedure (Group 2), it was 0.9% (7/743) (Group 1 versus Group 2, p = 0.42). Patients with significant coronary artery disease undergoing noncardiac operation without prior CABG (Group 3) had an increased operative mortality, 2.4% (11/458) (p = 0.009). Group 2 patients had more severe angina symptoms (p < 0.001) and more extensive coronary artery disease (p < 0.001) on entering CASS than Group 3 patients. Postoperative chest pain occurred in 8.7% (40/458) of the Group 3 patients versus 4.5% (18/399) in Group 1 and 5.1% (38/743) in Group 2 (p = 0.004). No group differences were noted for the incidence of perioperative myocardial infarction or arrhythmias.
Discriminant analysis revealed that a high left ventricular score (p < 0.001), preoperative nitrate use (p < 0.001), male sex (p < 0.003), diabetes (p < 0.004), age (p = 0.01), dyspnea on exertion (p = 0.01), and left ventricular hypertrophy noted on the electrocardiogram (p = 0.02) correlated independently with operative mortality, cardiovascular morbidity, or both.
This study supports the use of CABG in patients with significant coronary artery disease prior to their undergoing a major noncardiac operation, particularly when the defined increased risk factors exist.
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