Survival and functional status after coronary artery bypass grafting: Results 10 to 12 years after surgery in 500 patients

The survival and functional status of 500 consecutive patients who underwent isolated coronary artery bypass grafting from 1969 through 1972 were evaluated 10 to 12 years after surgery. Before operation, 88% of patients were in New York Heart Association class III or IV, and 84% of patients had two- or three-vessel involvement. Actuarial 10 year survival was 89 ± 4% for patients with one-vessel disease, 75 ± 4% for patients with two-vessel disease, and 62 ± 4% for patients with three-vessel disease. In addition to the number of vessels diseased, variables influencing 10 year survival were preoperative severity of congestive heart failure, presence of preoperative myocardial infarction, age, diseased ungrafted arteries, and severity of angina. During the follow-up period, 52% of patients had persisted or recurrent angina, and a history of subsequent myocardial infarction was found in 20% of patients. Of the 355 patients alive at the time of last follow-up, 69% were symptomatically improved in comparison with their preoperative status and 46% were angina free. Of all the preoperative and postoperative variables tested, only the presence of diseased but ungrafted arteries significantly influenced event-free survival, as defined by the absence of any of the following events: cardiac-related death, recurrence of angina pectoris, myocardial infarction, and repeat coronary artery bypass operation. We conclude that survival and late functional results 10 years after surgery are related to the severity of atherosclerosis and the adequacy of revascularization. This study provides data for comparison with results for patients who undergo coronary artery bypass surgery with current techniques for whom revascularization is more complete and early vein graft patency is high.