Repeat Coronary Revascularization after Coronary Artery Bypass Surgery in Older Adults: The Society of Thoracic Surgeons' National Experience 1991-2007
Background—A major 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 rates and predictors of repeat coronary revascularization following CABG in the modern era.
Methods and Results—We included STS National Adult Cardiac Surgery Database patients ≥65 years undergoing first-time isolated CABG from 1991-2007 (n=723,134, median age 73 years). After linking to Medicare claims data, long-term outcomes of CABG (up to 18 years post-surgery) were examined using cumulative incidence curves. Multivariable Cox proportional hazard analysis was used to identify factors associated with 1-year 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 (PCI or CABG, yet most often PCI) were 2%, 7%, 13%, and 16% at 1, 5, 10, and 18 years post-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 gender, disease severity represented by a history of PCI, pre-operative 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 two-fold variation in repeat revascularization rates across centers at 1 year (IQR 1.7%-3.6%) and at 5 years (IQR 6.7%-12.0%).
Conclusions—Repeat revascularization is infrequently performed among older patients who undergo CABG; however, these rates vary substantially by patient subgroups and among providers.
- Received February 6, 2013.
- Accepted March 15, 2013.