Pii: S1010-7940(99)00295-x

Objective: Coronary angiography data included in the analysis of operative mortality after coronary artery surgery are generally limited to left main coronary artery stenosis and classi®cation into one-, twoor three-vessel disease, but the role of stenoses and quality of distal runoff on each main coronary artery have never been analysed. The aim of this study was to assess the in ̄uence of coronary artery status (stenoses and distal runoff) on operative mortality in patients undergoing coronary artery surgery. Methods: Stenoses of the ®ve main coronary arteries and their distal runoff were prospectively evaluated in a series of 2461 patients undergoing isolated coronary artery surgery. These angiographic variables were included in analysis of operative mortality in combination with conventional preoperative data. Results: Univariate analysis founded 21 preoperative variables being signi®cant: age .70, body surface area ,1.8 m, arterial disease of lower limbs, history of peptic ulcer, CCS class IV angina, unstable angina, post-infarction unstable angina, congestive heart failure, left ventricular ejection fraction ,50%, urgency, preoperative intra-aortic balloon pump, previous myocardial infarction, previous cardiac surgery, previous coronary bypass graft, presence of signi®cant stenosis on the left main coronary artery or the circum ̄ex marginal branch or the distal circum ̄ex artery or the right coronary artery, absence of signi®cant stenosis on the left anterior descending artery, impaired distal runoff on the left anterior descending artery or the circum ̄ex marginal branch (for all, P , 0:05). Multivariate analysis identi®ed poor quality distal runoff in the left anterior descending artery and circum ̄ex marginal branch as independent risk factor (P ˆ 0:0005 and P ˆ 0:04, respectively), while left main coronary artery stenosis was not. This lesion appears to be a signi®cant risk factor only in a small subgroup of patients with CCS class IV angina. Other independent risk factors were CCS class IV angina, previous cardiac surgery, body surface area ,1.8 m, diabetes mellitus, age ,70, history of peptic ulcer, left ventricular ejection fraction ,50%. Impaired distal runoff or the presence of stenoses on the diagonal branch, right coronary artery, or distal circum ̄ex artery does not signi®cantly in ̄uence the operative mortality rate. Conclusions: The quality of distal runoff of the most frequently grafted vessels is a signi®cant risk factor for operative mortality in coronary artery surgery. Left main coronary artery stenosis was not identi®ed as a risk factor when these angiographic variables were included in the analysis. Functional status remains the most powerful predictive factor. q 1999 Elsevier Science B.V. All rights reserved.