Favourable long-term outcome after coronary artery bypass grafting in a nationwide cohort

Abstract

Objectives. In a nationwide cohort, we analyzed long-term outcome following coronary artery bypass grafting, using the combined strategy of left internal mammary artery to the left anterior descending artery and saphenous vein as secondary graft to other coronary targets. Methods. 1,507 consecutive patients that underwent myocardial revascularization during 2001–2012 in Iceland. Mean follow-up was 6.8 years. Major adverse cardiac and cerebrovascular events were depicted using the Kaplan-Meier method. Cox-regression was used to define risk factors. Relative survival was estimated by comparing overall survival to the survival of Icelanders of the same age and gender. Results. Mean age was 66 years, 83% were males, mean EuroSCOREst was 4.5, and 23% of the procedures were performed off-pump. At 5 years, 19.7% had suffered a major adverse cardiac or cerebrovascular event, 4.5% a stroke, 2.2% myocardial infarction, and 6.2% needed repeat revascularization. Overall 5-year survival was 89.9%, with a relative survival of 0.990. Independent predictors of major adverse cardiac and cerebrovascular events were left ventricular ejection fraction ≤30%, a previous history of percutaneous coronary intervention, chronic obstructive lung disease, chronic kidney disease, diabetes, and old age. The same variables and an earlier year of operation were predictors of long-term mortality. Conclusions. The long-term outcome following myocardial revascularization, using the left internal mammary artery and the great saphenous vein as conduits, is favourable and improving. This is reflected by the 5-year survival of 89.9%, deviating minimally from the survival rate of the general Icelandic population, together with a freedom from major adverse cardiac and cerebrovascular events of 80.3%.

Keywords:

• CABG
• LIMA
• long-term outcome
• survival
• MACCE
• relative survival

Acknowledgements

We thank Hannes Sigurjonsson and Saemundur Oddsson from the Cardiothoracic Research Team at Landspitali for helping with data collection and Gunnhildur Johannesdottir for secretarial help.

Disclosure statement

The authors report no conflicts of interest.

This work was supported by grants from the Landspitali University Hospital Research Fund, the University of Iceland Research Fund, and the Helga Gudmundsdottir and Sigurlidi Kristjansson Memorial Fund.

Additional information

Funding

Landspitali University Research

University of Iceland Research

Helga Gudmundsdottir and Sigurlidi Kristjansson MemorialHelga Gudmundsdottir and Sigurlidi Kristjansson Memorial FundLandspitali University Research FundUniversity of Iceland Research Fund

This work was supported by grants from the Landspitali University Hospital Research Fund, the University of Iceland Research Fund, and the Helga Gudmundsdottir and Sigurlidi Kristjansson Memorial Fund.