European Heart Journal Advance Access originally published online on December 9, 2008
European Heart Journal 2009 30(4):453-458; doi:10.1093/eurheartj/ehn530
The clinical outcome after coronary bypass surgery: a 30-year follow-up study
Thoraxcenter, Erasmus Medical Centre, Room Ba559, Dr Molewaterplein 40, Rotterdam, GD 3015, The Netherlands
Received 25 February 2008; revised 5 November 2008; accepted 18 November 2008; online publish-ahead-of-print 9 December 2008.
* Corresponding author. Tel: +31 10 703 3933, Fax: +31 10 704 9484, Email: r.vandomburg{at}erasmusmc.nl
Aims: To investigate the long-term clinical outcome (up to 30 years) after coronary artery bypass graft (CABG) surgery and to assess the life expectancy (LE) among subgroups of patients.
Methods and results: We analysed the 30-year outcome of the first 1041 consecutive patients in our institution (age at operation 53 years, 88% male) who underwent venous CABG between 1971 and 1980. During follow-up, every 5–7 years follow-up status was obtained by reviewing the hospital records and from general practitioners and civil registries. Data were collected on death and repeat coronary revascularization procedures. Follow-up was complete in 98%. Median follow-up was 29 years (26–36 years). The cumulative 10-, 20-, and 30-year survival rates were 77%, 40%, and 15%, respectively. Overall, 623 coronary re-interventions were performed in 373 patients (36%). The cumulative 10-, 20-, and 30-year freedom from death and coronary re-intervention rates were 60%, 20%, and 6%, respectively. Age [hazard ratio (HR) 1.04/year], extent of vessel disease (VD) (two-VD HR 1.4; three-VD HR 1.9), left main disease (HR 1.6) and impaired left ventricular ejection fraction (LVEF) (HR 1.8) were independent predictors of mortality. We were able to assess the exact LE by calculating the area under the Kaplan–Meier curves. Overall LE after first CABG was 17.6 years. LE in patients with one-, two-, and three-VD was 21.4, 18.8, and 15.4 years, respectively (P < 0.0001). Patients with impaired LVEF had a significant shorter LE than patients with normal LVEF (13.9% vs. 19.3%; P < 0.0001).
Conclusion: This 30-year follow-up study comprises the almost complete life cycle after CABG surgery. Overall median LE was 17.6 years. As the majority of the patients (94%) needed a repeat intervention, we conclude that the classic venous bypass technique is a useful but palliative treatment of a progressive disease.
Key Words: Life expectancy • Surgery • Prognsis • Survival • Mortality • Epidemiology