In this study, increased glycogen content in the myocardium, accompfished by preoperative glucose-insulin-potassium infusions, in patients operated for cardiac valvular diseases results in decreased myocardial damage, as judged from CK B leakage.

The aim of the study was to describe mortality during a period of two years after coronary artery bypass surgery (CABG) in relation to preoperative risk factors. Included were all the patients in western Sweden in whom CABG was performed between June 1988 and June 1991, without concomitant procedures or re-operations. The study was prospective in design. In all, 2000 patients with a median age of 64 years were operated upon. Early (within 30 days) mortality was 3.0% and late (30-day-2-year) mortality was 4.2%. Total two-year mortality was 7.1%. For patients undergoing coronary artery bypass grafting, the factors found to be independently predictive of early mortality were female sex, renal dysfunction (creatine clearance < 60ml/min), left main stenosis, number of diseased vessels, previous myocardial infarction, and functional class. We found that a history of congestive heart failure, a history of cerebrovascular disease, diabetes mellitus, renal dysfunction and intermittent claudication were independent risk factors for late mortality. In conclusion, with the exception of renal dysfunction, preoperative risk factors for death within 30 days after CABG differ from risk factors for death between 30 days and two years after CABG.

To derive and compare the need for hospitalization during 2 years prior to coronary artery bypass grafting (CABG) and 2 years after, all the patients from western Sweden in whom CABG without simultaneous valve surgery was performed between June 1988 and June 1991 were evaluated. Hospitalization prior to and after surgery was derived via questionnaires sent to the patients and via data from their hospital medical record forms. In all, 2099 patients were studied. The mean total number of days in hospital was 16 during the 2 years before and 24 including surgery and postoperative complications during the 2 years after the operation (p < 0.001). When the days for operation and postoperative complications were excluded, the mean number of days after operation was 7 (p < 0.001). Hospitalization due to myocardial infarction, angina pectoris, percutaneous transluminal coronary angioplasty and other investigations for heart disease were significantly reduced after CABG. On the other hand, hospitalization due to chest pain with causes other than ischemic heart disease, congestive heart failure, arrhythmias, and reoperation was more frequent during the 2 years after surgery. The total number of days in hospital was higher during the 2 years after CABG than during the 2 years before, despite the fact that hospitalization due to ischemic events was significantly reduced after the operation.

In 80 patients who underwent heart surgery the incidence of electrocardiographic (ECG) changes after the operation was analysed. A precordial grid containing 24 leads and leads II, III and aVF was used. Electrocardiographic measurements were taken the day before the operation and again 5 days after the operation. New Q-waves were observed in 2 patients (2.5%) in the 24 precordial leads, in 2 patients in leads II, III and aVF, and in one patient in both precordial leads and leads II, III and aVF. New T-wave inversions were observed in 20 patients (25%) in the 24 precordial leads, in 5 patients (6%) in leads II, III and aVF, and in 3 patients in both precordial leads and leads II, III and aVF. A similar serum enzyme activity was observed both in patients developing Q-waves as well as T-wave inversions compared with cases in whom ECG changes did not appear.

To describe the prognosis during 2 years after coronary artery bypass grafting (CABG) in relation to occurrence of and time since a previous acute myocardial infarction (AMI), data of all patients in western Sweden who underwent CABG without simultaneous valve surgery in the period June 1988-June 1991 were evaluated. In all, 2120 patients were included in the analyses. Of these, 1296 (61%) had a history of AMI and 127 (6%) had suffered an AMI within the last month before CABG. Mortality during the first 30 days after CABG was for patients with no previous AMI, previous AMI > 30 days prior to CABG, and previous AMI < or = 30 days prior to CABG 2.4%, 4.1%, and 5.5%, respectively (p < 0.05). The corresponding figures for the period between 30 days and 2 years after CABG were 3.6%, 4.4%, and 3.4% respectively (NS). In a multivariate analysis among patients with a previous AMI, a recent infarction (< or = 30 days prior to CABG) did not turn out as an independent predictor of death during 2 years of follow-up. A history of AMI was associated with increased mortality during the first 30 days but not thereafter, but recent AMI was not an independent predictor of total 2-year mortality.

All patients from western Sweden were retrospectively studied in whom CABG was performed between June 1, 1988 and June 1, 1991 without simultaneous valve surgery. The aim was to detect clinical factors prior to and at the time of coronary artery bypass grafting (CABG) which were associated with the risk of neurological complications during the postoperative hospital stay. A neurological complication during the hospital stay was registered if a neurological consultation was made and if this consultation diagnosed a neurological deficit. In all, there were 2121 patients in the study, of whom 81 (3.8%) had a neurological complication. 23 of the latter (28%) died before discharge. Among preoperative factors the following appeared as significant independent predictors of a neurological complication: a history of cerebrovascular disease (p < 0.001), diabetes mellitus (p < 0.01), hypertension (p < 0.05), degree of urgency of the operation (p < 0.01), and age (p < 0.01). Among pre- and post-operative events the following predicted a neurological complication: intensive care unit treatment for more than two days (p < 0.001) and respirator required for more than 24 hours (p < 0.001).

Coronary artery bypass grafting (CABG) is an established treatment for angina pectoris which conveys relief of chest pain and improved physical performance. However, increased survival has only been observed in selected subgroups of patients with advanced coronary artery disease, particularly in the presence of depressed left-ventricular ejection fraction (LVEF). It is therefore of interest to study whether the outcome in terms of quality of life (QoL) is also more favorable in candidates with depressed LVEF. All patients who underwent CABG without concomitant valve surgery in western Sweden between 6.1988 and 6.1991 (n = 2121) were sent questionnaires on QoL involving 3 different instruments, the Physical Activity Score, the Nottingham Health Profile, and the Psychological General Well-being Index. They were submitted before surgery and 3 times in the 2 years thereafter. QoL was improved on all postoperative occasions. The degree of improvement was not associated with preoperative LVEF for any of the instruments. The postoperative Physical Activity Score was associated with preoperative LVEF. The other instruments showed no such association with LVEF. The improvement in QoL during 2 years after CABG is not dependent on the LVEF determined prior to operation. Self-estimated physical abilities are postoperatively associated with preoperative LVEF whereas health-related QoL and general well-being are not.