EARLY OUTCOME OF CORONARY ARTERY BYPASS GRAFTING IN PATIENTS WITH UNSTABLE ANGINA
AbstractBackground: Unstable angina is a common causeof admission to hospitals. There is conflicting evidence on the need and success of urgent coronary revascularization in such cases. This study was conducted to evaluate the early post-operative morbidity and mortality of Coronary Artery Bypass Grafting (CABG) in patients with unstable angina. Methods: This cross sectional descriptive study was conducted at Choudry Pervaiz Elahi Institute of Cardiology, Multan. The data of the all the patients who had undergone CABG for unstable angina, between February 2009 and March 2010, was collected and analysed. Results: Total 35 patients of unstable angina had undergone CABG (M=29, F=6). Mean age was 58.25±9.62. Sixty five percent of the patients were from New York Heart Association (NYHA) class-IV. Regarding pre-operative risk factors, 35% had diabetes mellitus (DM), 22% had previous Myocardial infarction (MI), 3% had pulmonary Hypertension, 3% had uncontrolled hyperlipidemia, 40% had positive history of smoking, 17% had positive family history of IHD and 82% had triple vessel disease. None of the patients died. Mild ionotropic support was required in 48% of the patients. Two patients had acute confusional state; none of the patients had stroke or renal failure requiring dialysis. However 4 patients had disturbed renal profile. Pulmonary complications occurred in one patient. Conclusion: Coronary artery bypass surgery in patients with unstable angina has comparable morbidity and mortality in our setup and should be performed where indicatedKeywords: Unstable angina, CABG, IHD, outcome
Braunwald E. Unstable angina: A classification. Circulation 1989;80:410–4.
Loop FD, Berrettoni JN, Pichard A, Siegel W, Razavi M, Effler DB. Selection of the candidate for myocardial revascularization. A profile of high risk band on multivariate analysis. J Thorac Cardiovasc Surg 1975;69:40–51.
Jones RH, Hannan EL, Hammermeister KE, Delong ER, O'Connor GT, Luepker RV, et al. Identification of preoperative variables needed for risk adjustment of short-term mortality after coronary artery bypass graft surgery. J Am Coll Cardiol 1996;28:1478–87.
Lagerqvist B, Husted S, Kontny F, Näslund U, Ståhle E, Swahn E, et al. A long-term perspective on the protective effects of an early invasive strategy on unstable coronary artery disease: Two-year follow-up of the FRISC-II invasive study. J Am Coll Cardiol 2002;40:1902–14.
Cannon CP, Wientraub WS, Demopoous LA, Vicari R, Frey MJ, Lakkis N, et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tiro.ban. N Engl J Med 2001;344:1879–87.
Spacek R, Widimsky P, Straka Z, Jiresová E, Dvorák J, Polásek R, et al. Value of first day angiography/angioplasty in evolving non-ST-segment-elevation myocardial infarction: An open multicenter randomized trial. The VINO study. Eur Heart J 2002;23:230–8.
Cho L, Bhatt D L, Marso SP, Brennan D, Holmes DR Jr, Califf RM, et al. An invasive strategy is associated with decreased mortality in patients with unstable angina and non-ST elevation infarction. Am J Med 2003;114:106–11.
Fox KA, Poole-Wilson PA, Henderson RA Claton TC, Chambelain DA, Shaw TR, et al. Interventional versus conservative treatment for patients with unstable angina or Non-ST elevation myocardial infarction: the British Heart Foundation RITA 3 randomised trial. Randomized intervention trial of unstable angina investigators. Lancet 2002;360:743–51.
Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation 2004;110:1168–76.
Bjessmos, Hammar N, Sandberg E, Ivert T. Reduced risk of coronary artery bypass surgery for unstable angina during 6 years period. Eur J Cardio Thoracicsurg 2000;18:388–92.
Bertolasi CA, Tronge JE, Riccitelli MA, Villamayor RM, Zuffardi E. Natural history of unstable angina with medical or surgical therapy. Chest 1976;70: 596–605.
Luchi RJ, Scott SM, Deupree RH. Comparison of medical and surgical treatment for unstable angina pectoris. N Engl J Med 1987;316:977–84.
Anderson HV, Cannon CP, Stone PH, Williams DO, McCabe CH, Knatterud GL, et al. One-year results of the Thrombolysis in Myocardial Infarction IIIB clinical trial. A randomized comparison of tissue-type plasminogen activator versus placebo and early invasive versus early conservative strategies in unstable angina and non-Q wave myocardial infarction. J Am Coll Cardiol 2000; 35: 263.
Raja SG, Siddiqui H, Ilsley CD, Amrani M. In-hospital outcomes of off-pump multivessel total arterial and conventional coronary artery bypass grafting: single surgeon, single center experience. Ann Thorac Surg 2009;88:47–52.
Caggegi A, Capodanno D, Capranzano P, Chisari A, Ministeri M, Mangiameli A, et al. Comparison of one-year outcomes of percutaneous coronary intervention versus coronary artery bypass grafting in patients with unprotected left main coronary artery disease and acute coronary syndromes (from the CUSTOMIZE Registry). Am J Cardiol 2011;108:355–9.
Li XH, Xiao F, Li Y, Wang J, Song B, Yang Y, et al. Investigations of influential factors of acute renal injury after coronary artery bypass grafting. Beijing Da Xue Xue Bao 2009;41:554–7.
Ngaage DL, Cowen ME, Griffin S, Guvendik L, Cale AR. Early neurological complications after coronary artery bypass grafting and valve surgery in octogenarians. Eur J Cardiothorac Surg 2008;33:653–9.
Oliveira TM, Oliveira GM, Klein CH, Souza e Silva NA, Godoy PH. Mortality and complications of coronary artery bypass grafting in Rio de Janeiro, from 1999 to 2003. Arq Bras Cardiol 2010;95:303–12.
Boden WE, O’Rourke RA, Crawford MH, Blaustein AS, Deedwania PC, Zoble RG, et al. Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy. N Engl J Med 1998;339:1091