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[Aortocoronary bypass. 2. Long-term results evaluated in 318 survivors]
Insights
This study on coronary artery bypass grafting found that 80.3% of patients experienced angina relief. Surgical treatment significantly improved survival rates for patients with multi-vessel coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Outcomes Research
Context:
- Coronary artery bypass grafting (CABG) is a common surgical intervention for severe coronary artery disease.
- Long-term outcomes and graft patency are critical measures of CABG success.
- Understanding factors influencing functional results and survival is essential for patient management.
Purpose:
- To evaluate the long-term functional results and survival rates following coronary artery bypass grafting.
- To assess the patency of coronary artery bypass grafts and identify factors affecting it.
- To compare the efficacy of surgical versus medical treatment in patients with multi-vessel coronary artery disease.
Summary:
- A cohort of 318 patients surviving the first postoperative month were followed for a mean of 16.6 months.
- Complete angina disappearance was observed in 80.3% of patients, with persistent angina more common in females and those with three-vessel disease.
- Graft patency was 73% at 10.5 months, significantly higher when coronary arteriography was performed systematically (88.6%) versus indicated (63%).
- The cardio-thoracic ratio decreased significantly post-surgery.
- Actuarial survival curves indicated the superiority of surgical over medical treatment for patients with two or three-vessel coronary artery disease.
Impact:
- Coronary artery bypass grafting provides significant symptomatic relief and improves long-term survival in patients with multi-vessel coronary artery disease.
- Systematic postoperative coronary arteriography may improve graft patency assessment and patient outcomes.
- Findings highlight the importance of surgical intervention for specific patient subgroups with complex coronary artery disease.
Abstract:
Of the 318 patients surviving the first postoperative month 14 died secondarily, 5 were lost to follow-up, and 299 were therefore reviewed with a mean follow-up of 16.6 months (extremes of 2 and 42 months). The percentage of late infarcts was 5.9%. Complete disappearance of the angina occurred in 80.3% of patients. Persistant angina was commoner in females (p less than 0.05) and in patients with a lesion affecting all three trunks (p less than 0.05). On the other hand age, the clinical indications for bypass, the presence of an infarct preoperatively, and the development of an infarct immediately postoperatively did not affect the functional result. The cardio-thoracic ratio decreased significantly, from0.51 +/- 0.07 to 0.47 +/- 0.05 (p less than 0.001). 45 coronary arteriograms in a total of 63 grafts were analysed. 73% were patent after a follow-up period of 10.5 months. The patency rate was 88.6% when coronary arteriography was carried out systematically, and 63% (p less than 0.002) when it was indicated by persistant or recurrent angina. The actuarial survival curve in patients with 2 or 3 trunk involvement demonstrates clearly the superiority of surgical over medical treatment.