The influence of residual disease after coronary bypass on the 5-year survival rate of 1274 men with coronary artery disease
Coronary Artery Bypass
To determine the independent influence of the extent and site of residual disease on late survival, we analyzed the fate of 1448 consecutive patients who had coronary artery bypass surgery during 1968-1974. There were 1274 males, mean age 53.4 ± 8 years (range 24-75 years). Females were excluded from further analysis. 226 patients (17.7%) had one-vessel disease, 492 (38.6%) had two-vessel disease, 408 (32.0%) had three-vessel disease and 148 (11.6%) had left main stenosis. Survival was determined at a follow-up of at least 5 years. Survival data were analyzed by Kaplan-Meier survival curves for the patients with two- and three-vessel disease according to the extent of residual disease. For patients with two-vessel disease and good ventricular function, survival was similar at 5 years, 89.1% and 87.7% for no and one residual lesion; for those with two-vessel disease and poor ventricular function, 5-year survival was 84.5% and 52.6% for no and one residual lesion; for those with three-vessel disease and good ventricular function, it was 92.0%, 83.4%, and 75.0% for no, one and two residual lesions, respectively. With poor ventricular function, the corresponding results were 83.1%, 72.5% and 23.1%. The Cox multivariate analysis technique was used to analyze the influence of age at operation, number of vessels diseased preoperatively, preoperative left ventricular function, period of surgery, and the number and site of residual lesions after operation. Residual disease, age at operation and left ventricular function were the most important variables affecting survival of patients with two- and three-vessel disease. Residual lesions of the left anterior descending or circumflex coronary arteries were the most important predictors of survival; residual lesions of the right coronary artery exerted a lesser influence. The results of this study suggest that the greatest benefit in terms of improved survival may come from the first two to three grafts placed.