Long-Term Survival Following Coronary Artery Bypass Graft Surgery.

Background: Management guidelines for stable three-vessel coronary artery disease have become a subject of debate. We aim to provide a benchmark for the survival of patients with normal ejection fraction, stable three-vessel disease, and elective coronary artery bypass graft (CABG) surgery.

Methods: Data from consecutive patients with normal ejection fraction undergoing elective primary isolated CABG for triple-vessel disease in a diverse 11-center surgical network between 2008 and 2020 were analyzed. Survival data were obtained from the Centers for Disease Control and Prevention National Death Index and compared with an age- and sex-matched U.S.

Population: Mixed effects modeling with 'hospital' as a random effect was used to evaluate factors associated with all-cause mortality.

Results: Of 4,061 patients included in this analysis, 22% (893/4,061) were female and median age was 68 (IQR 61,74). Patients with elective CABG surgery for three-vessel disease and normal ejection fraction demonstrated improved survival compared to an age and sex-matched U.S. population, with significantly increasing relative survival over time. Factors associated with mortality included age ≥ 65 years (Hazard Ratio (HR) 1.71, p<0.001), male gender (HR 1.32, p=0.028), diabetes (HR 1.4, p=0.002), dialysis (HR 2.41, p=0.03), moderate or severe chronic lung disease (HR 1.68, p<0.001), and peripheral arterial disease (HR 2.05, p<0.001).

Conclusions: Patients with stable three vessel disease and normal ejection fraction who underwent elective CABG demonstrated improved survival compared to an age and sex-matched U.S.

Population: With this benchmark, further research can better elucidate the relative role of surgery and medical therapy in this patient population.