Spectrum of surgical risk for left main coronary stenoses: Benchmark for potentially competing percutaneous therapies☆,☆☆,★
Section snippets
Methods
Selected data on all patients with LMT stenosis of 50% or more undergoing CABG without valve repair or replacement at our institution from January 1, 1990, through December 31, 1995, were retrieved from a comprehensive relational database.2 Patients treated in the setting of acute myocardial infarction were excluded. The first 1000 patients who underwent CABG each year underwent prospective follow-up for clinical outcomes, and these data were retrieved. CABG was performed with accepted surgical
Results
Baseline characteristics of the 1585 patients are shown in Table I. The group is representative of patients from other recent CABG series,11, 12 except for the incidence of prior CABG. The 469 patients with long-term follow-up (0.9% not available for follow-up) did not differ from the entire group for any variable evaluated.
The overall in-hospital mortality rate was 2.3%, and median length of stay was 7 days. Independent correlates of in-hospital mortality rate are summarized in Table II, and
Discussion
Patients with left main coronary narrowing, especially narrowing of 70% or more,14 are recognized to be at high risk with medical therapy alone and to benefit from surgical revascularization.1 Generally excellent surgical results11, 12 and early reports of poor results with angioplasty4 for many years discouraged cardiologists from pursuing other means of revascularization for these patients. Recent advances, especially in stenting,15, 16 suggested to some groups that percutaneous
Acknowledgements
We thank the personnel from The Cleveland Clinic Foundation Cardiovascular Research Institute for their assistance in acquiring this information and Ms. Patti Durnwald for her expert preparation of this manuscript.
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From The Cleveland Clinic Foundation.
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Reprint requests: Stephen G. Ellis, MD, The Cleveland Clinic Foundation, 9500 Euclid Ave., F-25, Cleveland, OH 44195.
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