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(Circulation. 2003;107:1271.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Twenty-Year Survival After Coronary Artery Surgery

An Institutional Perspective From Emory University

William S. Weintraub, MD; Stephen D. Clements, Jr, MD; L. Van-Thomas Crisco, MD; Robert A. Guyton, MD; Joseph M. Craver, MD; Ellis L. Jones, MD; Charles R. Hatcher, Jr, MD

From the Division of Cardiology, Department of Medicine (W.S.W., S.D.C., L.V.-T.C.), and the Division of Cardiothoracic Surgery, Department of Surgery (R.A.G., J.M.C., E.L.J., C.R.H.), Emory University School of Medicine, Atlanta, Ga.

Correspondence to William S. Weintraub, MD, Professor of Medicine, Emory Center for Outcomes Research, 1256 Briarcliff Road, Suite 1N, Atlanta, GA 30306. E-mail wweintr{at}emory.edu

Background— Coronary artery bypass graft (CABG) surgery has been performed frequently for symptomatic coronary atherosclerotic heart disease for more than 30 years. However, uncertainty exists regarding the relationship between long-term survival after CABG and readily available clinical correlates of mortality.

Methods and Results— We studied outcome at 20 years by age, sex, and other variables in 3939 patients who had CABG surgery from 1973 to 1979 in the Emory University System of Healthcare. Twenty-year survival, freedom from myocardial infarction, and freedom from repeat CABG were 35.6% (95% confidence interval [CI], 33.9% to 37.3%), 66.6% (95% CI, 64.6% to 68.6%), and 59.1% (95% CI, 56.9% to 61.5%). Multivariate correlates of late mortality were age (hazard ratio [HR], 1.46 per 10 years), female sex (HR, 1.21), hypertension (HR, 1.44), angina class (HR, 1.07 per class increase of 1), prior CABG (HR, 1.72), ejection fraction (HR, 1.07 per 10-point decrease), number of vessels diseased (HR, 1.11 per 1-vessel increase), and weight (HR, 1.04 per 10 kg). Twenty-year survival by age was 55%, 38%, 22%, and 11% for age <50, 50 to 59, 60 to 69, and >70 years at the time of initial surgery. Survival at 20 years after surgery with and without hypertension was 27% and 41%, respectively. Similarly, 20-year survival was 37% and 29% for men and women.

Conclusions— Symptomatic coronary atherosclerotic heart disease requiring surgical revascularization is progressive with continuing events and mortality. Clinical correlates of mortality significantly impact survival over time and may help identify long-term benefits after CABG.

Key Words: coronary disease • surgery • survival • mortality

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