Mortality and recurrent cardiac events after coronary artery bypass graft: long term outcomes in a population study

Abstract

Objective: To determine 30 day mortality, long term survival, and recurrent cardiac events after coronary artery bypass graft (CABG) in a population. Design: Follow up study of patients prospectively entered on to a cardiothoracic surgical database. Record linkages were used to obtain data on readmissions and deaths. Patients: 8910 patients undergoing isolated first CABG between 1980 and 1993 in Western Australia. Main outcome measures: 30 day and long term survival, readmission for cardiac event (acute myocardial infarction, unstable angina, percutaneous transluminal coronary angioplasty or reoperative CABG). Results: There were 3072 deaths to mid 1999. 30 day and long term survival were significantly better in patients treated in the first five years than during the following decade. The age of the patients, proportion of female patients, and number of grafts increased over time. An urgent procedure (odds ratio 3.3), older age (9% per year) and female sex (odds ratio 1.5) were associated with increased risk for 30 day mortality, while age (7% per year) and a recent myocardial infarction (odds ratio 1.16) influenced long term survival. Internal mammary artery grafts were followed by better short and long term survival, though there was an obvious selection bias in favour of younger male patients. Conclusions: This study shows worsening crude mortality at 30 days after CABG from the mid 1980s, associated with the inclusion of higher risk patients. Older age, an acute myocardial infarction in the year before surgery, and the use of sephenous vein grafts only were associated with poorer long term survival and greater risk of a recurrent cardiac event. Female sex predicted recurrent events but not long term survival.

Long-term prognosis after coronary artery bypass surgery

“…A recent analysis by Domburg et al [11] from the Netherlands showed a 10-year mortality of 23% in a series of 1041 consecutive patients who underwent CABG in the 1970s and in the 1980s. In a population-based study from Western Australia, Bradshaw et al [22] found a 10-year mortality of 27% for men and 30% for women who had CABG between 1980 and 1993. A slightly higher mortality than in our study is explained by the inclusion of older age groups.…”

Determinants for an impaired quality of life 10 years after coronary artery bypass surgery

“…However, experiences indicate that a substantial part of the patients have recurrence of symptoms over time [4,5,21]. Therefore, in Table 2 Independent predictors of an inferior QoL 10 years after CABG-All survivors included NHP total score > 7.8 ( = median) p OR (95% ci) a PGWB total score < 105 ( = median) p OR (95% ci) a long-term perspective, many patients still have an impaired QoL [6,7].…”

“…However, during long-term follow-up the risk of symptom recurrence is substantial [4], which might adversely influence the outcome and patients' QoL. Although a large number of surveys have explored the QoL during the first few years after CABG [5,6] the experiences of QoL during long time after CABG are limited.…”

Moderate Exposure to Allogeneic Blood Products Is Not Associated with Reduced Long-term Survival after Surgery for Coronary Artery Disease

“…We can estimate an accurate death rate because Western Australia is an isolated state with little emigration of patients in this age group. Bradshaw et al 11 compared the Western Australia death register with the Australian National Death Index in a large cohort of subjects at nearby hospitals undergoing coronary artery surgery during a similar period of time; they found that less than 2% of deaths had been registered outside of Western Australia. If this proportion applied in the current study, then we would estimate that we missed six deaths because they were registered outside of Western Australia.…”