Influence of incremental preoperative risk factors on the perioperative outcome of patients undergoing emergency versus urgent coronary artery bypass grafting

A retrospective analysis of 127 patients with impending myocardial infarction undergoing coronary artery bypass grafting was performed to evaluate incremental risk factors associated with perioperative mortality and morbidity. Fifty-four patients (group 1) were operated upon as emergencies within 24 h and 73 patients underwent urgent coronary revascularization within a mean of 3.4 days (group II) after admission. The incidence of non-transmural myocardial infarctions (NTMI), haemodynamic parameters, the number of diseased vessels and the incidence of a preceding percutaneous coronary dilatation (PTCA) were not statistically different between the groups. The overall perioperative mortality was 8.7% (16.7% group I, 2.7% group II). Major non-fatal complications were frequent in the surviving collective including low cardiac output in 14 patients (12.1%) and transmural or subendocardial perioperative infarction in 12 patients (10.3%). Perioperative mortality was associated with reduced left ventricular myocardial function (P less than 0.001), operation within 24 hr after onset of anginal symptoms (P less than 0.001) or subendocardial infarction (P less than 0.025) in the 4 weeks before operation. Perioperative mortality was independent of the degree of coronary stenosis, number of distal anastomoses or performance of a coronary endarterectomy. Of the patients, 90.5% (87.5% of group I and 92.3% of group II) included in a mean follow-up of 16.8 months (range 5-27 months) were graded into Canadian Heart Functional Class I. Successful coronary surgery for acute myocardial ischaemia results in excellent late functional recovery. The major risk factors for fatal perioperative outcome are reduced left ventricular function and the necessity of every early surgical intervention.