George T. Christakis, M. D. , Stephen E. Fremes, M. D. , Richard D

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Presentation transcript:

Reducing the risk of urgent revascularization for unstable angina: A randomized clinical trial George T. Christakis, M.D., Stephen E. Fremes, M.D., Richard D. Weisel, M.D., M.Mindy Madonik, B.Sc., Jennifer H. McDonough, C.C.P., Jacques G. Tittley, M.D., Donald A.G. Mickle, M.D., Joan Ivanov, R.N., Lynda L. Mickleborough, M.D., Bernard S. Goldman, M.D., Ronald J. Baird, M.D. Journal of Vascular Surgery Volume 3, Issue 5, Pages 764-772 (May 1986) DOI: 10.1016/0741-5214(86)90041-8 Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 Incidence (%) of mortality, myocardial infarction, and low-output syndrome was significantly lower in patients randomized to receive blood cardioplegia. Journal of Vascular Surgery 1986 3, 764-772DOI: (10.1016/0741-5214(86)90041-8) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 Postoperative release of the cardiac isoenzyme, CK-MB, was significantly lower in patients randomized to receive blood cardioplegia. CK-MB enzymes were assayed between 2 and 48 hours after cross-clamp (XCL) removal. Journal of Vascular Surgery 1986 3, 764-772DOI: (10.1016/0741-5214(86)90041-8) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Morbidity and highest postoperative CK-MB value was greater in patients who did not respond to medical therapy and who were randomized to receive crystalloid than blood cardioplegia. Patients who had incomplete response to medical therapy had lower morbidity when they received blood cardioplegia. Journal of Vascular Surgery 1986 3, 764-772DOI: (10.1016/0741-5214(86)90041-8) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 Morbidity and highest postoperative CK-MB release was greater in patients who had persistent electrocardiographic (ECG) changes preoperatively and were randomized to receive crystalloid than blood cardioplegia. Patients with normal or transiently ischemic ECG and patients with persistently ischemic ECG changes had lower morbidity after blood cardioplegia. Journal of Vascular Surgery 1986 3, 764-772DOI: (10.1016/0741-5214(86)90041-8) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 Multivariate analysis determined that the type of cardioplegic protection (p = 0.008) and the patient's age (p = 0.05) were independent predictors of postoperative morbidity. Combined effects of cardioplegic protection and age on predicted postoperative morbidity (%) are depicted along with 70% confidence limits. Predicted logarithmic odds of an event quantifies relative risk of morbidity on the basis of combination of cardioplegic type (CP Type) and age. Patients who received blood cardioplegia (bld) had lower incidence of morbidity than patients who received crystalloid cardioplegia (crys) at younger (37 years) and older (73 years) ages. Journal of Vascular Surgery 1986 3, 764-772DOI: (10.1016/0741-5214(86)90041-8) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions