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Do nonfatal events during the first 5 years after coronary artery bypass surgery influence 10 year outcomes?
Rodolfo V Rocha1, Terrence M Yau1, Anna Chu2
1Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Insights
Experiencing major adverse cardiac and cerebrovascular events (MACCE) within five years after coronary artery bypass grafting (CABG) significantly reduces long-term survival and increases future adverse events. Preventing early MACCE after CABG is crucial for improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Clinical Outcomes Research
- Long-term Patient Monitoring
Background:
- Long-term survival after coronary artery bypass grafting (CABG) is critical.
- Early adverse events post-CABG may impact long-term prognosis.
- Limited data exists on the influence of early major adverse cardiac and cerebrovascular events (MACCE) on late outcomes.
Purpose of the Study:
- To investigate the impact of nonfatal MACCE within the first 5 years after CABG on survival and subsequent adverse events at 10 years.
- To analyze the association between early MACCE and long-term mortality and morbidity following CABG.
- To identify strategies for improving late outcomes after CABG by focusing on early event prevention.
Main Methods:
- Retrospective analysis of 20,444 patients undergoing isolated CABG (1990-2014) in Ontario, Canada.
- Primary endpoint: all-cause mortality; Secondary endpoint: MACCE (mortality, myocardial infarction, stroke, repeat revascularization).
- Propensity score matching created 2167 patient-pairs comparing early MACCE vs. no early MACCE groups.
Main Results:
- 11% of patients experienced nonfatal MACCE within 5 years post-CABG.
- The early MACCE group showed significantly worse overall survival (HR 1.42) and freedom from MACCE (HR 1.61) at 10 years.
- Within the early MACCE group, high rates of myocardial infarction (44.9%), stroke (24.0%), and repeat revascularization (43.7%) were observed within 5 years.
Conclusions:
- Nonfatal MACCE in the first 5 years after CABG is linked to poorer long-term survival and increased adverse events.
- Preventing major adverse events early after CABG is a key strategy for enhancing late outcomes.
- Focusing on early post-operative care and risk factor management can improve long-term prognosis for CABG patients.
Objective:
Few have examined the influence of early adverse events after coronary artery bypass grafting (CABG) on long-term survival. We sought to determine if the occurrence of nonfatal major adverse cardiac and cerebrovascular events (MACCE) during the first 5 years after CABG influences survival and adverse events at 10 years.
Methods:
All patients who underwent isolated CABG from 1990 to 2014 at a single center in Ontario, Canada, were included. Primary end point was all-cause mortality. The secondary end point of interest was MACCE, a composite of mortality, nonfatal myocardial infarction, stroke, and repeat revascularization.
Results:
A total of 20,444 cases of elective primary isolated CABG were identified as being alive at 5 years, with 11% of patients developing nonfatal MACCE within the first 5 years after CABG (MACCE group) and the remaining 89% were alive without a MACCE event at 5 years (non-MACCE group). Following propensity score matching, 2167 patient-pairs were formed. Among the MACCE group, 972 out of 2167 (44.9%) developed a myocardial infarction, 519 out of 2167 (24.0%) had a stroke, and 946 out of 2167 (43.7%) required a repeat revascularization within the first 5 years after CABG. Non-MACCE was associated with better overall survival (hazard ratio, 1.42; 95% CI, 1.25-1.63; P < .01) and freedom from MACCE (hazard ratio, 1.61; 95% CI, 1.45-1.79; P < .01) up to 10 years after CABG compared with MACCE cases.
Conclusions:
Patients who experienced nonfatal MACCE during the first 5 years after CABG experienced worse survival and more MACCE at 10 years. Prevention of major adverse events during the first 5 years after surgical revascularization may be an important strategy to improve late outcomes.
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