title: Repeat coronary revascularization after coronary artery bypass surgery in older adults: the Society of Thoracic Surgeons' national experience, 1991-2007.
abstract: BACKGROUND
  A major advantage of coronary artery bypass graft surgery (CABG) relative to percutaneous coronary intervention is its durability, yet there is a paucity of information on rates and predictors of repeat coronary revascularization after CABG in the modern era.
  
  
  RESULTS
  We included patients ≥65 years from the Society of Thoracic Surgeons' National Adult Cardiac Surgery Database who were undergoing first-time isolated CABG from 1991 to 2007 (n=723 134, median age 73 years). After linking to Medicare claims data, long-term outcomes of CABG (up to 18 years after surgery) were examined by use of cumulative incidence curves. Multivariable Cox proportional hazard analysis was used to identify factors associated with 1- and 5-year repeat revascularization trends and variability. We found that the overall 18-year survival rate was 20%. Cumulative incidences of any repeat revascularization (percutaneous coronary intervention or CABG, yet most often percutaneous coronary intervention) were 2%, 7%, 13%, and 16% at 1, 5, 10, and 18 years after surgery, respectively. The rates of repeat CABG procedures were quite low for all time points (0.1%, 0.6%, 1.3%, and 1.7%, respectively). Female sex, disease severity represented by a history of percutaneous coronary intervention, preoperative dialysis, and partial revascularization were strongly associated with a higher revascularization rate, whereas advanced age, left main disease, and smoking were associated with a lower rate. There was approximately a 2-fold variation in repeat revascularization rates across centers at 1 year (interquartile range 1.7-3.6%) and 5 years (interquartile range 6.7-12.0%).
  
  
  CONCLUSIONS
  Repeat revascularization is performed infrequently among older patients who undergo CABG; however, these rates vary substantially by patient subgroups and among providers.
authors.affiliation: Duke Clinical Research Institute, 2400 Pratt St, Durham, NC 27705, USA. emil.fosbol@duke.edu
authors.forename: Emil L
authors.initials: EL
authors.lastname: Fosbøl
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhao
authors.forename: David M
authors.initials: DM
authors.lastname: Shahian
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Grover
authors.forename: Fred H
authors.initials: FH
authors.lastname: Edwards
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D023903:Coronary Restenosis / Q000601:surgery* / Q000628:therapy; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D009765:Obesity / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012955:Societies, Medical; D015996:Survival Rate; D013903:Thoracic Surgery; D014481:United States / Q000453:epidemiology