What is the generic survival rate for coronary artery bypass graft (CABG) surgery?

From the Guidelines

The generic survival rate for bypass surgery is approximately 95% at 5 years, with a mortality rate of 5.3% after CABG, and a subsequent mortality rate of 1.5% after vascular surgery, as reported in the 2009 ACCF/AHA Perioperative Guidelines 1.

Key Factors Influencing Survival Rate

• The patient's age and overall health status play a significant role in determining the survival rate after bypass surgery.
• The presence of other medical conditions, such as diabetes or kidney disease, can also impact the outcome.
• Left ventricular function and the urgency of the procedure are additional factors that influence the survival rate.

Long-term Survival Rates

• According to the study by Fleisher et al, the cumulative 5-year survival rate for patients who received coronary bypass was 72%, compared to 43% for those who did not undergo the procedure 1.
• The study also found that fatal cardiac events occurred within a mean of 4.6 years in 12% of patients who received coronary bypass, compared to 26% of those who did not 1.

Importance of Perioperative and Long-term Cardiac Risk

• The study by Eagle et al found that patients who underwent prior CABG had a lower risk of death and nonfatal MI after noncardiac surgery, especially those with multivessel CAD and severe angina 1.
• The European Coronary Surgery Study Group reported that the long-term survival rate was 85% after coronary bypass surgery, compared to 57% for nonsurgical treatment in patients with peripheral vascular disease 1.

Medication Management and Graft Patency

• Patients who undergo bypass surgery typically need to take medications such as aspirin, statins, beta-blockers, and ACE inhibitors to maintain graft patency and reduce cardiovascular risk factors.
• The use of these medications can significantly impact long-term survival and reduce the risk of cardiac events.

From the Research

Generic Survival Rate for Bypass Surgery

The generic survival rate for bypass surgery can be understood through various studies that have examined the outcomes of patients undergoing coronary artery bypass grafting (CABG).

• A study from 2 presented actuarial survival rates for patients who underwent CABG, showing an operative mortality of 3.7% and a late mortality of 9.2% over a follow-up period exceeding 5 years.
• Factors such as age, poor left ventricular function, and the presence of clinical cardiac failure were associated with a poor prognosis, as identified in the study 2.
• Another study from 3 found that patients who experienced nonfatal major adverse cardiac and cerebrovascular events (MACCE) during the first 5 years after CABG had worse survival and more MACCE at 10 years, highlighting the importance of preventing major adverse events to improve late outcomes.
• The use of statins and aspirin in patients with previous CABG is crucial for long-term benefits, as shown in the study 4, where only 67% of patients were being prescribed a statin and 75% were prescribed aspirin, with 52% prescribed both.
• Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin has been associated with reduced risk of major adverse cardiovascular and cerebrovascular events within 6 months after CABG, as compared with aspirin monotherapy, without a significant increase in major bleeding, as found in the study 5.
• The study 6 discussed the effects of dual antiplatelet therapy and anticoagulation on graft patency rates and clinical outcomes after CABG, indicating that DAPT does not lead to improved graft patency rates or clinical outcomes over aspirin monotherapy for on-pump CABG, but may have protective effects in off-pump CABG.

Survival Rates and Outcomes

• The annual mortality rate seemed to be less in patients with triple vessel disease after myocardial revascularisation, as observed in the study 2.
• Patients with severe angina or unstable angina who had been treated medically before surgery had the same results as those treated surgically by first intention, suggesting an argument in favour of initial medical management in all forms of angina, as noted in 2.
• The long-term functional results were interesting, with 67% of patients followed up to 5 years and 56% of patients followed up for over 5 years having no angina, and myocardial infarction occurring in 16.7% of patients at 5 years, as reported in 2.