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Ann Thorac Surg 1989;47:569-574
© 1989 The Society of Thoracic Surgeons
Department of Surgery, St. Louis University Medical Center and St. Mary's Health Center, St. Louis, Missouri, USA
* Address reprint requests to Dr Naunheim, Department of Surgery, St. Louis University Medical Center, 3635 Vista Ave at Grand Blvd, PO Box 15250, St. Louis, MO 63110-0250.
Unstable angina pectoris is a broad, nonspecific diagnosis encompassing a wide variety of clinical syndromes. The intravenous administration of nitroglycerin prsoperatively is indicative of a mors acute clinical situation, and allows for selection and analysis of a more homogeneous patient population. We reviewed the results of coronary artery bypass grafting for unstable angina defined as angina necessitating intravenous administration of nitroglycerin preoperatively. There were 129 patients (83 men and 46 women) with a mean age of 63.2 years (range, 36 to 86 years). Complications included operative death in 6.2%, postoperative low cardiac output in 11%, and perioperative myocardial infarction in 9%. Twenty perioperative variables were analyzed to identify risk factors for these end points. For operative death, age (p < 0.05), cross-clamp time (p < 0.05), and cardiopulmonary bypass time (p < 0.001) were significant is the univariate analysis, but only age (p < 0.05, F = 4.6) was an independent predictor using muitivariate analysis (stepwise linear regression). For low cardiac output, univariate analysis demonstrated that cross-clamp time (p < 0.01), preoperative use of an intraaortic ballon for angina (p < 0.05), left ventricular score (p < 0.05), number of diseased coronary vessels (p < 0.05), and cardiopulmonary bypass time (p < 0.001) were significant variables. However, only use of an intraaortic balloon for angina (p < 0.0001, F = 14.3) and left ventricular score (p < 0.005, F = 11.1) were significant independent predictors in the multivariate model. For perioperative myocardial infarction, only diabetes requiring insulin (p < 0.005) was a significant predictor.
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