Survival benefit of coronary-artery bypass grafting accounted for deaths in those who remained untreated
Currently there are no direct estimates of mortality reduction afforded by coronary-artery bypass grafting (CABG) that take into account the deaths of patients for whom the treatment was indicated but who remained untreated.
Methods: We used a population-based registry to identify patients with established coronary artery disease who were to undergo first-time isolated CABG. We measured the effect of surgical revascularization on survival after the treatment decision in two cohorts of patients categorized by symptoms, coronary anatomy, and left ventricular function.
Results: One in 10 patients died during the five years after treatment decision.
The hazard of death among patients who underwent CABG was 51 percent of that for the untreated group, the adjusted hazard ratio was 0.51 (95 percent confidence interval, 0.43 to 0.61). The effect was stronger when CABG was performed within the recommended time: adjusted hazard ratios were 0.43 (95 percent confidence interval, 0.35 to 0.53) and 0.58 (95 percent confidence interval, 0.48 to 0.70) for early and late intervention, respectively; chi-square for the difference between hazard ratios was 12.2 (P<0.001).
Conclusion: Estimates that account for patients who died before they could undergo a required CABG indicate a significant survival benefit of performing early surgical revascularization even for non-urgent patients.
Author: Boris G Sobolev, Guy Fradet, Robert Hayden, Lisa Kuramoto, Adrian R Levy and Mark J FitzGerald
Credits/Source: Journal of Cardiothoracic Surgery 2008, 3:47
Published on: 2008-07-17
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
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