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Titolo:
Urgent surgical revascularization of unstable angina. Influence of double mammary arteries
Autore:
Bonacchi, M; Prifti, E; Giunti, G; Frati, G; Sani, G;
Indirizzi:
Univ Florence, Dept Cardiac Surg, I-50134 Florence, Italy Univ Florence Florence Italy I-50134 rdiac Surg, I-50134 Florence, Italy IRCCS NEUROMED, I-86077 Pozzilli, Italy IRCCS NEUROMED Pozzilli Italy I-86077 NEUROMED, I-86077 Pozzilli, Italy
Titolo Testata:
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
fascicolo: 4, volume: 20, anno: 2001,
pagine: 747 - 754
SICI:
1010-7940(200110)20:4<747:USROUA>2.0.ZU;2-2
Fonte:
ISI
Lingua:
ENG
Soggetto:
ACUTE MYOCARDIAL-INFARCTION; ACUTE CORONARY SYNDROMES; THROMBOLYTIC THERAPY; BYPASS-SURGERY; ANGIOPLASTY; RISK; PECTORIS; REPERFUSION; MANAGEMENT; TRIAL;
Keywords:
unstable angina; coronary artery bypass grafting; emergency surgery; double mammary arteries;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
25
Recensione:
Indirizzi per estratti:
Indirizzo: Bonacchi, M Univ Florence, Dept Cardiac Surg, I-50134 Florence, Italy UnivFlorence Florence Italy I-50134 I-50134 Florence, Italy
Citazione:
M. Bonacchi et al., "Urgent surgical revascularization of unstable angina. Influence of double mammary arteries", EUR J CAR-T, 20(4), 2001, pp. 747-754

Abstract

Objective: Aim of this study was to evaluate retrospectively: (1) the outcome in patients with unstable angina (UA) refractory to the medical therapyundergoing urgent-emergent CABG (2) the influence of both IMAs employment. Patients and methods: Between January 1995 and July 2000. 576 (28.5%) consecutive patients with UA underwent CABG procedure. 182 (31,6%. Group I) patients, presenting unstable hemodynamic or angina pectoris refractory to themaximal medical therapy, underwent urgent/emergent CABG. 397 (68.4%, GroupII) patients, after the maximal medical therapy did not present angina's episodes or ECG alterations and underwent elective CABG procedure. Preoperative data were similar in the two groups. Both IMAs were used in 68 (37.4%) patients of I and 152 (38%) of II (P > 0.05) to left side revascularization. Results: CAD extension was greater in Group I: 45 (24.7%) patients presented ischemia in >1 area vs 53 (13.5%) in II (P < 0.001). Incidence of anteroseptal ischemia resulted significantly higher in I (P = 0.017): left main coronary artery stenosis was present in 68 (37%) patients in 1 vs 108 (27%)in II (P = 0.01). LV function resulted significantly depressed in I. demonstrated by a significantly lower LVEF (P < 0.001), higher NYHA class (P < 0.001) and preoperative incidence of IABP (P < 0.001). Intraoperative data analysis did not reveal any difference between groups, Hospital mortality was 13 (7%) and 21 (5.3%) patients in I and II respectively (P = ns). Multivariate analysis of all preoperative and intraoperative variables revealed the age > 65 years (P = 0.01), congestive heart failure (P < 0.001), LVEF < 35% (P = 0.03). >1 ischemic area (P = 0.02) as strong predictors for poor overall survival. and LIMA (P = 0.006) and both IMAs (P = 0.001) as strong predictors for good overall survival. Actuarial survival at 1, 3 and 5 years resulted to be 98.5, 96.5 and 90% in I and 99, 96 and 92% in II (P = ns). Conclusion: CABG has been associated with acceptable outcome in patients with UA which should be applied soonest possible in patients refractory to medical treatment. Total coronary revascularization and employment of both IMAs for left myocardial side are associated with low operative risk and incidence of complications, permit to have acceptable short and long-term outcome in this pool of patients. (C) 2001 Elsevier Science BN. All rights reserved.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 20/01/20 alle ore 10:15:50