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Eur J Cardiothorac Surg 2000;18:388-392
© 2000 Elsevier Science NL
a Department of Thoracic Surgery, Thoracic Surgical Clinic, Karolinska Hospital, S-171 76 Stockholm, Sweden
b Department of Epidemiology, Karolinska Hospital, S-171 76 Stockholm, Sweden
c Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
Received 29 December 1999; received in revised form 11 April 2000; accepted 18 April 2000.
Corresponding author. Tel.: +46-8-51774825; fax: +46-8-331931
e-mail: torbjorn.ivert{at}kirurgi.ki.se
Objective: To assess the risk of early death or acute myocardial infarction in patients undergoing isolated coronary artery bypass surgery for unstable coronary artery disease. Methods: Retrospective observational study of 853 patients operated on because of unstable coronary artery disease during 1990–1995. Results: There were 5.9% deaths and 13.0% nonfatal infarctions 
30 days. These figures declined during the observation period and were 2.6% and 6.2%, respectively, in 1995. The relative risk of early death or myocardial infarction was 50% less during 1994–1995 than during 1990–1991, after multivariate adjustment for several patient risk factors. The risk of death or infarction was almost twice as high in patients 
50 years than in those <50 years of age. Multivariate analysis showed that aortic-cross-clamp time 60 min, previous bypass surgery, pre-operative heart failure, emergency surgery, worse Braunwald class and non-use of an internal mammary artery graft were associated with an increased risk of death or infarction. Early mortality was 3.4% (24/702) in unstable patients without symptoms of congestive heart failure, who were not operated on emergently after failed percutaneous coronary intervention and had not had previous cardiac surgery. Conclusions: We observed a marked reduction of the risk of early death or myocardial infarction after surgery for unstable angina during the 6-year period 1990–1995. The risk reduction was not explained from operations performed on patients with less risk and indicates improved peri-operative patient management.
Key Words: Coronary artery bypass surgery • Unstable angina • Risk factors
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