The clinical outcome after coronary bypass surgery: a 30-year follow-up study.
OBJECTIVE
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.


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).


CONCLUSIONS
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.
van Domburg
Ron T
RT
Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands. r.vandomburg@erasmusmc.nl
Kappetein
Arie Pieter
AP
Bogers
Ad J J C
AJ
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000401:mortality / Q000601:surgery*; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011788:Quality of Life; D012086:Reoperation / Q000706:statistics & numerical data; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome