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  • Title: Early and late mortality after surgery for unstable angina in relation to Braunwald class.
    Author: Bjessmo S, Ivert T, Flink H, Hammar N.
    Journal: Am Heart J; 2001 Jan; 141(1):9-14. PubMed ID: 11136481.
    Abstract:
    BACKGROUND: The prognostic value of the preoperative Braunwald class of unstable angina to predict early and long-term outcome after urgent coronary artery bypass grafting (CABG) has not been studied previously. METHODS: Deaths were recorded after all primary isolated CABG performed for unstable (n = 992) and stable (n = 5376) angina pectoris during 1980-1995. Severity of symptoms in the unstable patients was classified according to Braunwald. RESULTS: Death within 30 days of surgery occurred in 4.6% of the patients having unstable angina and in 1.6% of those with stable angina. Early mortality was 2.5% in Braunwald class II, 4.9% in class IIIB, and 6. 2% in class IIIC unstable patients. The risk of early death, after adjustment for risk factors, was about four times higher in Braunwald class IIIB (odds ratio [OR] 4.3, 95% confidence interval [CI] 2.4-7.7) and IIIC (OR 4.7, 95% CI 2.2-10.3) patients than in stable patients. The risk of death during postoperative months 1 to 6 tended to be higher (relative risk 2.4, 95% CI 0.8-7.1) in Braunwald class IIIC patients than in stable patients. After the first 6 months up to 5 years, survival rates in all Braunwald classes were similar to those in patients operated on for stable angina. CONCLUSIONS: There was a higher risk of early death after urgent bypass surgery in patients with Braunwald class III unstable angina than after elective CABG. The long-term survival rates after the first 6 postoperative months was similar in stable and unstable patients, regardless of preoperative Braunwald class.
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