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Similar survival 15 years after coronary artery surgery irrespective of left main stem stenosis
Torbjörn Ivert1, Bengt Brorsson
1Department of Cardiothoracic Surgery and Anaesthesiology, Karolinska University Hospital, Stockholm, Sweden. torbjorn.ivert@karolinska.se
Insights
Fifteen-year survival after coronary artery bypass grafting (CABG) was similar regardless of left main stenosis (LMS) or right coronary artery (RCA) obstruction. Clinical factors, not LMS or RCA obstruction, predicted long-term outcomes post-CABG.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Coronary artery bypass grafting (CABG) is a primary treatment for severe coronary artery disease.
- The impact of left main stenosis (LMS) and right coronary artery (RCA) obstruction on long-term survival after CABG requires further elucidation.
- Understanding prognostic factors is crucial for patient management and risk stratification.
Purpose of the Study:
- To evaluate 15-year survival rates following CABG.
- To assess the influence of left main stenosis (LMS) and right coronary artery (RCA) obstruction on long-term outcomes.
- To identify predictors of mortality after CABG.
Main Methods:
- Prospective collection of coronary angiographic data from 977 patients undergoing CABG for stable angina (1994-1995).
- Patients were categorized based on the presence and severity of LMS and RCA obstruction.
- Survival analysis was performed at 15 years, with multivariable analysis to identify risk factors for death.
Main Results:
- No significant difference in early mortality or 15-year survival was observed among groups with no LMS, LMS without RCA obstruction, or LMS with RCA obstruction (51%, 47%, 47% survival, respectively).
- Significant LMS was present in 20% of patients; significant RCA obstruction was common in both LMS and non-LMS groups.
- Older age, smoking, severe angina, positive stress test, hypertension, diabetes mellitus, and reduced ejection fraction (<50%) were identified as independent risk factors for 15-year mortality.
Conclusions:
- Fifteen-year mortality after CABG is associated with clinical variables, not the presence of left main stenosis (LMS) with or without significant right coronary artery (RCA) obstruction.
- The anatomical severity of LMS and associated RCA obstruction does not appear to be a primary predictor of long-term survival post-CABG.
- Clinical risk factor assessment is paramount for predicting long-term outcomes in patients undergoing CABG.
Objectives:
To evaluate 15-year survival after coronary artery bypass grafting (CABG) in relation to grade left main stenosis (LMS) and right coronary artery (RCA) obstruction.
Design:
Coronary angiographic findings were prospectively collected in 977 patients who had CABG for stable angina during 1994-1995 and were included in the Swedish Coronary Revascularization - Swedish Council of Technology Assessment study.
Results:
Significant LMS was present in one fifth of the patients and significant RCA obstruction was found in 61% of those with LMS and in 68% of patients without LMS. The patients were categorized as no LMS (Group I), LMS without RCA obstruction (Group II) or significant LMS with significant right coronary artery (RCA) obstruction (Group III). Early mortality did not differ in the three groups and was 1.2, 1.2% and 0.8% in group I, II and III, respectively. Corresponding survival at 15 years was similar 51%, 47% and 47%, respectively. In multivariable analysis older age, smoking, severe angina, positive stress test, hypertension, diabetes mellitus and ejection fraction < 50% were risk factors for death at 15 years.
Conclusions:
Death 15 years after CABG correlated to clinical variables but was not predicted from presence of LMS with or without significant associated RCA obstruction.
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