Abstract 12525: The Long-term Need for Repeat Coronary Revascularization after Coronary Artery Bypass Surgery: the Society of Thoracic Surgeons' National Experience, 1990-2007
Background: An advantage of coronary artery bypass graft surgery (CABG) relative to percutaneous coronary intervention (PCI) is its durability, yet there is a paucity of information on the long-term need for and predictors of repeat coronary revascularization following CABG in the modern era.
Methods: We included patients 65 years and older undergoing first-time isolated CABG from 1991 to 2007 (n=723,134, median age 73 years) included in the Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database linked to Medicare claims data. Long-term outcomes (up to 18 years following CABG) were examined using cumulative incidence and Kaplan-Meier curves. Multivariable Cox proportional hazard analysis was used to identify factors associated with 1-year and 5-year repeat revascularization trends and their variability among United States centers.
Results: By 18 years following CABG, the overall survival rate was 20% in this older cohort. Cumulative incidences of any repeat revascularization (PCI or CABG) were 2%, 7%, 13%, and 16% at 1, 5, 10, and 18 years post-surgery, respectively, driven predominately by PCI (Figure). The rates of repeat CABG were low throughout all time periods (0.1%, 0.6%, 1.3%, and 1.7%, respectively). Female gender, a history of PCI, pre-operative dialysis, and incomplete revascularization were associated with higher risk for repeat revascularization, whereas advanced age was associated with a lower revascularization rate. There was modest variation in repeat revascularization rates across centers at 1 year (IQR 1.7% to 3.6%) and at 5 years (IQR 6.7-12.0%).
Conclusion: Among older CABG patients, the need for repeat revascularization is infrequent, yet these rates do vary substantially by patient subgroups and among providers.
- © 2012 by American Heart Association, Inc.