Increased risk of urgent revascularization

To determine the risk factors for operative mortality and morbidity, we performed a prospective analysis of 1,980 patients undergoing isolated coronary artery bypass operations between 1982 and 1984. The operative mortality was 3.5%, and the incidence of perioperative myocardial infarction was 8.6% and low output syndrome, 12.0%. Stepwise logistic regression identified sex, preoperative left ventricular ejection fraction, and the urgency of operation as independent risk factors for postoperative mortality. Urgent revascularization was performed in patients with unstable angina refractory to maximal medical therapy. In these patients the operative mortality was 8.5%. Independent risk factors of postoperative morbidity, in addition to sex, ejection fraction, and urgent revascularization, included a previous bypass procedure, age, and New York Heart Association functional class. Unstable angina unresponsive to medical therapy contributed significantly to the operative risk. Interventions to reduce perioperative ischemic injury, such as improved methods of myocardial protection, may improve the results in high-risk patients.