Key result
Myocardial revascularization with coronary endarterectomy was associated with higher in-hospital mortality compared to revascularization without endarterectomy (9.3% vs 5.7%; p=0.003).
Why the study?
Does myocardial revascularization with coronary endarterectomy increase in-hospital mortality compared to revascularization without endarterectomy?
Cohort (n=353)
Does myocardial revascularization with coronary endarterectomy increase in-hospital mortality compared to revascularization without endarterectomy?
Absolute Event Rate: 9.3% vs 5.7%
p-value: p=0.003
Coronary endarterectomy during myocardial revascularization is associated with increased in-hospital mortality, particularly in high-risk patients with diabetes, left main disease, or low ejection fraction.
Supports caution with endarterectomy during revascularization; leaves open its net benefit in selected high-risk patients.
OBJECTIVE: To determine the risk factors for mortality related to myocardial revascularization when performed in association with coronary endarterectomy. METHODS: We assessed retrospectively 353 patients who underwent 373 coronary endarterectomies between January '89 and November '98, representing 3.73% of the myocardial revascularizations in this period of time. The arteries involved were as follows: right coronary artery in 218 patients (58.45%); left anterior descending in 102 patients (27.35%); circumflex artery in 39 patients (10.46%); and diagonal artery in 14 patients (3.74%). We used 320 (85.79%) venous grafts and 53 (14.21%) arterial grafts. RESULTS: In-hospital mortality among our patients was 9.3% as compared with 5.7% in patients with myocardial revascularizations without endarterectomy (p=0.003). Cause of death was related to acute myocardial infarction in 18 (54.55%) patients. The most significant risk factors for mortality identified were as follows: diabetes mellitus (p=0.001; odds ratio =7.168), left main disease (<0.001; 9.283), female sex (0.01; 3.111), acute myocardial infarction (0.02; 3.546), ejection fraction <35% (<0.001; 5.89), and previous myocardial revascularization (<0.001; 4.295). CONCLUSION: Coronary endarterectomy is related to higher mortality, and the risk factors involved are important elements of a poor outcome.
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Atik et al. (2000) conducted a cohort in Coronary artery disease requiring myocardial revascularization (n=353). Coronary endarterectomy during myocardial revascularization vs. Myocardial revascularization without endarterectomy was evaluated on In-hospital mortality (p=0.003). Myocardial revascularization with coronary endarterectomy was associated with higher in-hospital mortality compared to revascularization without endarterectomy (9.3% vs 5.7%; p=0.003).
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