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Mortality and recurrent cardiac events after coronary artery bypass graft: long term outcomes in a population study
P J Bradshaw1, K Jamrozik, M Le
1School of Population Health, University of Western Australia, Western Australia, Australia. pamela.bradshaw@health.wa.gov.au
Insights
Coronary artery bypass graft (CABG) outcomes showed worsening crude mortality over time, linked to higher-risk patients. Factors like older age and recent heart attack increased mortality risk and recurrent cardiac events.
Area of Science:
- Cardiovascular Surgery
- Outcomes Research
Background:
- Coronary artery bypass graft (CABG) is a major cardiac procedure.
- Long-term survival and recurrent cardiac events are critical outcome measures.
Purpose of the Study:
- To determine 30-day mortality, long-term survival, and recurrent cardiac events following coronary artery bypass graft (CABG).
Main Methods:
- A prospective follow-up study of 8910 patients undergoing isolated first CABG between 1980 and 1993 in Western Australia.
- Data linkage was used to track readmissions and deaths up to mid-1999.
Main Results:
- 30-day and long-term survival were better in the earlier period (1980-1988) compared to the later period (1988-1993).
- Increased risk for 30-day mortality was associated with urgent procedures, older age, and female sex.
- Older age and recent myocardial infarction influenced long-term survival. Internal mammary artery grafts showed better survival, though with selection bias.
Conclusions:
- Crude 30-day mortality after CABG worsened from the mid-1980s due to the inclusion of higher-risk patients.
- Older age, recent myocardial infarction, and exclusive use of saphenous vein grafts were linked to poorer long-term survival and recurrent cardiac events.
- Female sex predicted recurrent events but not long-term survival.
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.
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