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Circulation, Vol 67, 302-309, Copyright © 1983 by American Heart Association
BR Chaitman, EL Alderman, LT Sheffield, T Tong, L Fisher, MB Mock, RD Weins, GC Kaiser, D Roitman, R Berger, B Gersh, H Schaff, MG Bourassa and T Killip
There are few data on the long-term effects of new Q waves on survival and
morbidity after coronary bypass graft surgery (CABG). We followed 1340
patients who underwent CABG in 1978 at 10 hospitals participating in the
Coronary Artery Surgery Study (CASS). The incidence of perioperative Q-wave
infarction was 4.76% (range 0.0-10.3% by hospital). The rate of infarction
was higher in patients who had an increased left ventricular end-diastolic
pressure or cardiomegaly on the preoperative chest radiograph. Patients who
received more grafts or who had longer cardiopulmonary bypass time were
also at higher risk of infarction. In a stepwise discriminant analysis of
44 clinical, angiographic and surgical variables, cardiopulmonary bypass
time, topical cardiac hypothermia and cardiomegaly entered the stepwise
selection of variables. Long-term survival was adversely affected by the
appearance of new postoperative Q waves. The hospital mortality was 9.7% in
the 62 patients who had new postoperative Q waves and 1.0% in the 1278
patients who did not (p less than 0.001); the 3-year cumulative survival
rates were 85% and 95%, respectively (p less than 0.001). In patients who
survived to hospital discharge, the presence of new postoperative Q waves
did not adversely affect 3-year survival (94% and 96%, respectively). The
survival rates were worse in patients who had a history of infarction or
who had impaired left ventricular function preoperatively. The number of
readmissions to hospital after CABG among the patients who had a transmural
perioperative infarction was similar to to that among patients who did not.
We conclude that the appearance of new Q waves after CABG adversely affects
survival. The major impact on mortality occurs before hospital discharge.
Patients who are destined to have a perioperative infarct cannot be
predicted from commonly measured preoperative and angiographic variables.
ARTICLES
Use of survival analysis to determine the clinical significance of new Q waves after coronary bypass surgery
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