Similar survival 15 years after coronary artery surgery irrespective of left main stem stenosis

Figures & data

Table I. Characteristics in 977 patients undergoing coronary artery bypass grafting in relation to grade left main stenosis (LMS) and right coronary artery (RCA) stenosis.

			≥ 50% LMS (n = 214)
		< 50% LMS	< 70% RCA stenosis	≥ 70% RCA stenosis
	Total	Group I	Group II	Group III	p Value
No. patients (%)	977 (100)	763 (78%)	83 (9%)	131 (13%)
Age (mean; ± SD)	64 (9)	64 (9)	65 (9)	66 (8)	0.032
Age < 60 (%)	275 (28)	223 (29)	26 (31)	26 (20)	0.253
Age 60–69 (%)	386 (40)	298 (39)	31 (37)	57 (43)
Age ≥ 70 (%)	316 (32)	242 (32)	26 (31)	48 (37)
Female gender (%)	196 (20)	145 (19)	23 (28)	28 (21)	0.157
Smoking (%)	133 (14)	106 (14)	8 (10)	19 (15)	0.534
Severe angina (%)	592 (61)	452 (59)	48 (58)	92 (70)	0.051
Positive stress test (%)*	654 (71)	496 (69)	61 (78)	97 (78)	0.030
Hypertension (%)	374 (38)	291 (38)	36 (43)	47 (36)	0.539
Hyperlipidaemia (%)	138 (14)	106 (14)	11 (13)	21 (16)	0.787
Previous AMI (%)	488 (50)	406 (53)	22 (27)	60 (46)	<0.001
Diabetes mellitus (%)	183 (19)	147 (19)	16 (19)	20 (15)	0.551
LVEF < 50% (%)	308 (32)	247 (32)	14 (17)	47 (36)	0.008
IMA graft (%)	860 (89)	669 (89)	75 (90)	116 (89)	0.917
≥ 5 Anastomoses	404 (42)	297 (39)	39 (47)	68 (52)	0.016

AMI = acute myocardial infarction; LVEF = left ventricular ejection fraction; IMA = internal mammary artery.

*61 patients did not have a stress test.

Table II. Angiographic distribution of grade left main stenosis (LMS) and right coronary artery (RCA) obstructions in 977 patients.

			≥ 50% LMS (n = 214)
		< 50% LMS	< 70% RCA stenosis	≥ 70% RCA stenosis
	Total	Group I	Group II	Group III
No. patients (%)	977 (100)	763 (78%)	83 (9%)	131 (13%)
Percent RCA Obstruction	n (%)	n (%)	n (%)	n (%)
<30%	133 (14)	102 (13)	31 (37)
30- < 50%	58 (6)	50 (7)	8 (10)
50- < 70%	139 (14)	95 (12)	44 (53)
70- < 99%	318 (32)	253 (33)		65 (50)
100%	329 (34)	263 (35)		66 (50)

Figure 1. Survival up to 15 years after coronary artery bypass grafting in relation to severity of left main stenosis (LMS) and right coronary artery (RCA) stenosis.

Table III. Survival after coronary artery bypass grafting in relation to grade left main stenosis (LMS) and right coronary artery (RCA) obstruction.

		≥ 50% LMS (n = 214)
	< 50% LMS stenosis	< 70% RCA stenosis	≥ 70% RCA stenosis
	Group I	Group II	Group III
No. patients (%)	763 (78%)	83 (9%)	131 (13%)
Survival	%	%	%
30 days	98.8	98.8	99.2
5 years	91.0	88.0	87.0
10 years	75.2	67.5	74.0
15 years	51.4	47.0	46.6
Patients at risk	n	n	n
30 days	754	82	130
5 years	694	73	114
10 years	574	56	97
15 years	392	39	61

Table IV. Multivariable analyses of risk factors for death in 977 patients up to 15 years after coronary artery bypass grafting in relation to grade left main stenosis (LMS) and right coronary artery (RCA) obstruction.

		≥ 50% LMS (n = 214)
	< 50% LMS stenosis	≥ 70% RCA stenosis	< 70% RCA stenosis
	Group I	Group II	Group III
	763 (78%)	83 (9%)	131 (13%)
	HR	HR (95% CI)	HR (95% CI)
All patients	1.0	1.07 (0.79–1.45)	1.23 (0.97–1.54)
Adjusted for age	1.0	1.02 (0.76–1.39)	1.07 (0.85–1.35)
Adjusted for AMI	1.0	1.14 (0.84–1.55)	1.25 (0.99–1.57)
Multivariable*	1.0	1.21 (0.89–1.65)	1.04 (0.82–1.31)

HR = hazard regression; 95% CI = 95% confidence interval.

*Adjusted for age, angina severity, positive stress test, previous myocardial infarction diabetes mellitus, ejection fraction < 50% and ≥ 5 distal anastomoses.

Figure 2. Survival of all studied patients compared to that in an age, gender and date of surgery adjusted cohort of the Swedish Population. The 95% confidence interval (95% CI) for survival in patients who had coronary artery bypass grafting is shown.

Table V. Analysis of risk factors for death in all 977 patients at 15 years after coronary artery bypass grafting.

No. patients (%)	Univariate			Multivariable
	HR	CI = 95%	p Value	HR	CI = 95%	p Value
Age < 60	1			1
Age 60–69	2.26	(1.87–2.73)	< 0.001	2.58	(2.05–3.06)	< 0.001
Age ≥ 70	4.67	(3.60–6.07)	< 0.001	4.50	(3.45–6.08)	< 0.001
Female gender	1.10	(0.89–1.37)	0.157	1.24	(0.98–1.56)	0.069
Smoking	1.30	(1.04–1.64)	0.022	1.74	(1.37–2.23)	< 0.001
Severe angina	1.40	(1.18–1.67)	0.051	1.32	(1.10–1.59)	0.003
Positive stress test*	1.58	(1.06–2.37)	0.030	1.63	(1.08–2.46)	0.019
Hypertension	1.10	(0.93–1.30)	0.539	1.28	(1.07–1.53)	0.008
Hyperlipidaemia	1.08	(0.85–1.37)	0.787	1.08	(0.84–1.40)	0.532
Previous AMI	1.30	(1.10–1.53)	< 0.001	1.17	(0.97–1.40)	0.108
Diabetes mellitus	1.45	(1.18–1.77)	< 0.001	1.43	(1.16–1.77)	0.001
LVEF < 50%	1.66	(1.40–1.97)	0.008	1.45	(1.20–1.76)	< 0.001
IMA graft. n = 964	1.14	(0.86–1.50)	0.917	1.03	(0.76–1.40)	0.848
≥ 5 distal anastomoses	1.24	(1.05–1.47)	0.016	1.14	(0.95–1.37)	0.171

HR = hazard ratio; 95% CI = 95% confidence interval.

*61 patients did not have a stress test.