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Early and late survival after coronary-artery surgery
M H Rowe1, C J Mullany, A L White
1University Department of Surgery, Open Heart Surgical Unit, St Vincent's Hospital, Fitzroy.
Insights
This study on coronary-artery surgery found that while survival rates are good, patients operated on directly from the Coronary Care Unit faced higher mortality. Recurrent angina also remains a long-term concern.
Area of Science:
- Cardiovascular Surgery
- Medical Outcomes Research
Background:
- Coronary-artery surgery (CAS) is a critical intervention for ischemic heart disease.
- Understanding long-term outcomes and mortality predictors is essential for improving patient care.
Purpose of the Study:
- To analyze hospital mortality and long-term survival after isolated coronary-artery surgery.
- To identify predictors of mortality and recurrent angina post-surgery.
Main Methods:
- Retrospective analysis of 1801 patients undergoing CAS between 1970 and 1985.
- Data collected on patient demographics, surgical factors, and outcomes including mortality and angina recurrence.
- Statistical analysis using Cox regression to determine significant predictors.
Main Results:
- Hospital mortality was 3.5%, with significantly higher rates for patients from the Coronary Care Unit (8.9% vs 2.1%).
- Key mortality predictors included CCU admission, left main coronary-artery stenosis, and earlier year of surgery.
- Five-year and 10-year survival rates were 88% and 65%, respectively. Recurrent angina affected 21% at five years, predicted by year of surgery and prior myocardial infarction.
Conclusions:
- While isolated CAS offers reasonable long-term survival, specific patient groups (e.g., CCU patients) and surgical factors significantly impact outcomes.
- Left main coronary-artery stenosis and the year of surgery are critical factors for both mortality and long-term angina recurrence.
- Increased use of mammary arterial grafts may improve long-term angina outcomes.
Abstract:
Between 1970 and 1985, 1801 patients underwent coronary-artery surgery without associated valvular surgery. Eighty-four per cent of patients were male and the mean (+/- SD) age was 55.7 +/- 8.3 years. Of the patients, 18.7% were from the Coronary Care Unit and 6.5% had diabetes. The hospital mortality rate for the whole group was 3.5%. Patients from the Coronary Care Unit had the highest (8.9%) hospital mortality rate compared with those patients who were not from the Coronary Care Unit (2.1%; P less than 0.001). Other factors which increased the hospital mortality rate significantly were the number of diseased vessels (P less than 0.01), the degree of left main coronary-artery stenosis (P less than 0.001), an earlier year of surgery (P less than 0.01) and female sex (P less than 0.01). After these were taken into account, no other factors (for example, age, preoperative infarction, presence of left-ventricular aneurysm, left-ventricular end-diastolic pressure, diabetes, use of mammary-arterial grafts or the need for endarterectomy) affected the mortality rate. Patients were followed-up for a mean (+/- SD) of 4.4 +/- 2.8 years. The five-year survival rate for all patients was 88% and the 10-year survival rate was 65%. Cox regression analysis showed that the significant indicators of decreased long-term survival were undergoing operation directly from the Coronary Care Unit (P less than 0.001), left main coronary-artery stenosis (P less than 0.01), the number of grafted vessels (P less than 0.01), concomitant surgery for aneurysm (P less than 0.001), year of surgery (P less than 0.01). Seventy-nine per cent of patients were free of angina pectoris at five years after operation. The year of surgery (P less than 0.001) and preoperative myocardial infarction (P less than 0.05) were the best predictors of recurrent angina. In the long term, recurrent angina remains a problem, although this may change with the increased use of mammary-arterial grafts.