Circulation, Vol 63, 793-802, Copyright © 1981 by American Heart Association
JW Kennedy, GC Kaiser, LD Fisher, JK Fritz, W Myers, JG Mudd and TJ Ryan
Fifteen institutions participating in the Collaborative Study in Coronary
Artery Surgery (CASS) have performed isolated coronary artery bypass
surgery upon 6630 patients (1061 women and 5569 men) for coronary artery
disease. The overall operative mortality (OM) was 2.3% (range 0.3-6.4%).
Mortality increased with age, from 0 in the group 20- 29 years old to 7.9%
in the group 70 years and older. OM was higher for women in each group,
ranging from 2.8% for ages 30-39 years to 12.3% for age 70 years and older
(0.8% and 5.8% for men). Clinical manifestations of congestive heart
failure were associated with increased OM. Mortality was 1.4% in
one-vessel, 2.1% in two-vessel and 2.8% in three-vessel disease (diameter
narrowing greater than or equal to 70%). Among 1019 patients with left main
coronary artery (LMCA) stenosis, OM ranged from 1.6% in patients with mild
stenosis and a right-dominant system to 25% in patients with severe
(greater than or equal to 90%) stenosis and left dominance. OM varied with
ejection fraction (EF) (1.9% for EF greater than or equal to 50% to 6.7%
for EF less than 19%) and left ventricular wall motion score (1.7% for
least abnormal to 9.1% for most abnormal). For elective surgery, OM was
1.7%, for urgent surgery 3.5%, and for emergency surgery 10.8%. Mortality
was 40.0% among 30 patients with severe LMCA stenosis who underwent
emergency revascularization. Advanced age, female sex, symptoms of heart
failure, LMCA stenosis, impaired left ventricular function and nonelective
surgery are associated with a higher OM. These factors should be considered
in the selection of patients for coronary artery surgery.
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Clinical and angiographic predictors of operative mortality from the collaborative study in coronary artery surgery (CASS)
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