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Changes in patients undergoing coronary artery bypass grafting: 1987-1990. Northern New England Cardiovascular
D L Disch1, G T O'Connor, J D Birkmeyer
1Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756.
Insights
Patient characteristics for coronary artery bypass grafting (CABG) changed significantly between 1987-1990. Older patients with lower ejection fractions underwent more urgent procedures, increasing predicted mortality.
Area of Science:
- Cardiovascular Surgery
- Public Health
Background:
- Coronary artery bypass grafting (CABG) is a critical intervention for coronary artery disease.
- Understanding patient demographic and clinical trends is essential for evaluating surgical outcomes and resource allocation.
Purpose of the Study:
- To analyze changes in patient characteristics and predicted mortality among isolated CABG patients over a defined period.
- To identify factors contributing to observed trends in CABG patient populations.
Main Methods:
- Prospective study of 7,590 isolated CABG patients across three US states (1987-1990).
- Assessment of trends in age, sex, surgical priority, ejection fraction, left ventricular end-diastolic pressure, and left main coronary artery stenosis.
- Linear regression analysis to evaluate trends and predicted in-hospital mortality.
Main Results:
- Significant increase in mean patient age and a decrease in ejection fraction.
- Rise in the proportion of urgent CABG cases, with a corresponding decrease in elective procedures.
- Predicted in-hospital mortality increased from 4.2% to 5.2%, primarily driven by increased urgency of surgical intervention.
Conclusions:
- The patient cohort undergoing CABG experienced substantial changes between 1987 and 1990, including an aging population and a shift towards more urgent surgeries.
- These evolving patient characteristics necessitate careful consideration when interpreting CABG outcomes and comparing data across different time periods.
Abstract:
A prospective study of 7,590 consecutive patients undergoing isolated coronary artery bypass grafting at five medical centers in Maine, New Hampshire, and Vermont between July 1987 and December 1990 assessed changes in patient characteristics over time. Variables included age, sex, surgical priority, ejection fraction, left ventricular end-diastolic pressure, and left main coronary artery stenosis of 90% or greater. Trends were assessed for each variable and for predicted mortality using linear regression. The mean age increased significantly, whereas ejection fraction decreased. The percentage of urgent cases increased, whereas the elective cases became less frequent. No changes were observed in the percentages of emergent cases, female patients, or patients with severe left main coronary artery disease. The predicted in-hospital mortality rose significantly from 4.2% to 5.2% (p < 0.001). The increase in urgent surgical intervention was the most substantial contributor. Subgroup analyses did not support a systematic misclassification of elective patients into the urgent group. This study demonstrates that the characteristics of the cohort of patients undergoing coronary artery bypass grafting changed substantially from 1987 to 1990. These changes should be considered when interpreting surgical outcomes.