Improved survival after 5 years in 1,144 patients after coronary bypass surgery.

To determine the influence of coronary bypass surgery on late survival, 1,144 consecutive patients were contacted 60 to 76 months after operation. There were 1,000 men (87.4 percent). The mean age was 50.1 years (range 24 to 75). Operation was performed for angina pectoris with coronary lesions of more than 70 percent reduction in luminal diameter in 1,101 patients (96.2 percent). Forty-three patients (3.8 percent) had congestive heart failure without angina and 240 (21.0 percent) had both heart failure and angina. Unstable angina was present in 149 patients (13 percent). Previous myocardial infarction had occurred in 675 patients (59 percent). Single vessel disease was present in 226 patients (19.8 percent), double vessel disease in 442 (38.6 percent), triple vessel disease in 376 patients (32.9 percent) and greater than 50 percent stenosis of the left main coronary artery in 100 patients (8.7 percent). The overall operative mortality rate was 4.6 percent (52 patients). With exclusion of patients with left main coronary artery disease, this rate was 3.8 percent (40 of 1,044) and the overall crude 5 year survival rate was 89.1 percent (930 of 1,044). The survival rates of men and women were comparable. Left ventricular function was classified as good if end-diastolic pressure was less than 15 mm Hg and the left ventriculogram revealed no aneurysmal or akinetic area. Among men, the respective survival rates for each subgroup and for those with good left ventricular function within that subgroup were as follows: one vessel disease, 92.9 percent (169 of 182) and 94.9 percent (130 of 137); two vessel disease, 90.3 percent (352 of 390) and 94.3 percent (248 of 263); three vessel disease, 85.7 percent (293 of 342) and 90.9 percent (189 of 208); left main coronary artery disease, 81.4 percent (70 of 86) and 90.6 percent (48 of 53). The graft patency rate in 157 patients was 86.4 percent (247 of 286 grafts), and 149 patients (94.9 percent) had at least one patent graft.Late survival of all patients with reasonably good preoperative left ventricular function was normal compared with the expected number of survivors based on the general U.S. population experience of 1973. Thus, the survival rates of surgically treated patients with reasonable preoperative left ventricular function, regardless of anatomic lesions, are restored to survival rates comparable with those of the general population. With poor ventricular function, survival is impaired but is still superior to that reported with medical treatment only.