Education & Fellowships

Cardiothoracic Surgery Service
LAC+USC Medical Center Student Handout

Coronary Artery Disease

• Coronary Artery Disease (CAD) is one of the leading causes of death in the US.
• Approximately 250-300,000 coronary surgeries are performed in the US / year.
• Approximately 250-300,000 Percutaneous Transluminal Coronary Angioplasties (PTCAs) are performed in the US / year.
• Risk factors for developing coronary artery disease:
  • family history
  • diabetes mellitus
  • hypertension
  • hypercholesterolemia
  • smoking
• Differentiate between coronary atherosclerosis and ischemic coronary artery disease. Ischemic disease involves areas of myocardium at risk for a myocardial infarct because of a hemodynamically significant stenosis proximally. This gives classic signs of angina pectoris.
• Indications for Coronary Artery Bypass Grafting (CABG):
  • unstable angina
  • Left Main coronary disease
  • multiple vessel disease with crescendo angina refractory to medication
  • high grade proximal LAD diseasepost-infarction angina
  • complication of myocardial infarction (ventricular wall rupture, ventricular septal defect, papillary muscle dysfunction--acute mitral regurgitation).
  • complication of failed PTCA.
• Common statistics for CABG:
  • operative mortality 1-3%
  • peri-operative myocardial infarction 3%
  • post-operative wound infection 3%
  • post-operative bleeding 3-5%
  • post-operative arrhythmias 30%

• Recurrent Coronary Artery Disease
  • reoperation for recurrent angina is 3%/year
  • operative mortality for re-do CABG 5-7%
  • morbidity for re-do CABG 2x
  • reoperation is usually needed because:
    • Incomplete initial revascularization
    • Poor control of hypertension, cholesterol, diabetes
    • Continued smoking
    • Non-use of the IMA
    • Progressive atherosclerosis
• 30% of the patients that undergo CABG will need "something" else done in their lifetime--re-do CABG, PTCA, etc. The hope is that by the time a further intervention is necessary, technology will have advanced and the outcome will be better.

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