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Published on: March 27, 2018
Thirty-Year Mortality After Coronary Artery Bypass Graft Surgery: A Danish Nationwide Population-Based Cohort Study
Kasper Adelborg1, Erzsébet Horváth-Puhó2, Morten Schmidt2
1From the Department of Clinical Epidemiology (K.A., E.H.-P., M.S., T.M., L.P., H.T.S.), Department of Cardiology (K.A., H.E.B.), and Department of Cardiothoracic Surgery (P.H.N.), Aarhus University Hospital, Skejby, Denmark. kade@clin.au.dk.
Insights
Long-term mortality after coronary artery bypass graft (CABG) surgery remains elevated compared to the general population, particularly in the early post-operative period and beyond 10 years. This nationwide study highlights significant survival differences for CABG patients.
Area of Science:
- Cardiovascular Surgery
- Public Health
- Epidemiology
Background:
- Long-term mortality data following coronary artery bypass graft (CABG) surgery are limited.
- Understanding post-surgical survival is crucial for patient management and healthcare planning.
Purpose of the Study:
- To investigate and compare short-term and long-term mortality rates in patients who underwent CABG surgery versus a matched general population cohort.
- To identify specific time intervals with increased mortality risk after CABG.
Main Methods:
- A nationwide, population-based cohort study utilizing Danish registry data from 1980-2009.
- Inclusion of 51,307 CABG patients and 513,070 matched general population individuals.
- Analysis of mortality risk ratios across different time intervals post-surgery.
Main Results:
- CABG patients exhibited higher mortality than the general population, especially within 0-30 days (3.2% vs 0.2%) and 11-30 years (51.1%-62.4% vs 35.6%-44.8%).
- Adjusted mortality rate ratios were significantly elevated within 30 days (13.51) and 11-30 years (1.62-1.76) post-CABG.
- Increased risk of death from myocardial infarction, heart failure, and stroke was observed within 30 days for CABG patients.
Conclusions:
- Patients undergoing isolated CABG surgery face a higher long-term mortality risk compared to the general population.
- The most pronounced mortality differences occur within 30 days and between 10 to 30 years after surgery.
- Absolute mortality rates varied significantly based on patient baseline risk factors.
Background:
Data are sparse on long-term mortality after coronary artery bypass graft (CABG) surgery. We examined short-term and long-term mortality of patients undergoing CABG surgery and a general population comparison cohort.
Methods And Results:
Linking data from Danish registries, we conducted a nationwide, population-based cohort study on 51 307 CABG patients and 513 070 individuals from the general population matched on age, sex, and calendar year (1980-2009). The mortality risk was higher in patients having isolated CABG surgery than in the general population, particularly during 0 to 30 days (3.2% versus 0.2%), 11 to 20 years (51.1% versus 35.6%), and 21 to 30 years (62.4% versus 44.8%), but not substantially higher during 31 to 364 days (2.9% versus 2.4%) or 1 to 10 years (30.7% versus 25.8%). The 30-day adjusted mortality rate ratio for isolated CABG surgery was 13.51 (95% confidence interval [CI], 12.59-14.49). Between 31 to 364 days and 1 to 10 years, the isolated CABG surgery cohort had a slightly higher mortality rate than the general population comparison cohort, adjusted mortality rate ratios of 1.15 (95% CI, 1.09-1.21) and 1.09 (95% CI, 1.08-1.11), respectively. Between 11 to 20 years and 21 to 30 years, the adjusted mortality rate ratios were 1.62 (95% CI, 1.58-1.66) and 1.76 (95% CI, 1.62-1.91). Within 30 days, CABG patients had a 25-fold, a 26-fold, and a 18-fold higher risk of dying from myocardial infarction, heart failure, or stroke, respectively, than members of the general population comparison cohort. We found substantial heterogeneity in absolute mortality rates according to baseline risk groups.
Conclusions:
The isolated CABG cohort had a higher mortality rate than the general population comparison cohort, especially within 30 days of and 10 years after surgery.
