Freedom from first coronary reintervention after CABG was 99% at 1 year, declining to 46% at 25 years, with younger age and diabetes increasing reintervention risk.
Does extensive arterial grafting and risk factor modification reduce the need for reintervention in patients undergoing primary isolated CABG?
Reintervention after CABG is common over long-term follow-up, but the risk can be significantly reduced by utilizing extensive arterial grafting and aggressive risk factor modification.
Background— Reintervention after coronary artery bypass grafting (CABG) is common. We sought to determine its occurrence and identify patient characteristics and operative techniques that influence the need or bias for reintervention. Methods and Results— From 1971 to 1998, 48 758 patients underwent primary isolated CABG, and 1000 patients per year were actively followed-up every 5 years (n =26 927). A multivariable time-related analysis was performed to model freedom from first coronary reintervention (either reoperation or percutaneous coronary intervention) and identify patient and operative characteristics associated with first reintervention. A total of 3997 patients underwent coronary reintervention, percutaneous in 1638 and reoperation in 2359. Freedom from reintervention was 99%, 96%, 88%, 73%, 60%, and 46% at 1, 5, 10, 15, 20, and 25 years, respectively. Risk of reintervention (hazard function) demonstrated a short, rapidly declining early phase followed by a longer, slow-rising late phase. Patient variables increasing the likelihood of coronary reintervention included younger age ( P <0.0001), higher triglycerides ( P= 0.002), lower high-density lipoprotein ( P= 0.006), diabetes mellitus ( P <0.0001), and more extensive coronary artery disease ( P= 0.0005). Increasing extent of arterial grafting performed at primary operation decreased the likelihood of coronary reintervention ( P <0.0001). Conclusions— Reintervention after primary CABG is common. Risk factors for arteriosclerosis and type of bypass conduit influence the need or bias for repeat coronary therapy. Aggressive post-CABG risk factor reduction and extensive arterial grafting at primary operation should decrease coronary reinterventions.
Sabik et al. (2006) studied this question. Freedom from first coronary reintervention after CABG was 99% at 1 year, declining to 46% at 25 years, with younger age and diabetes increasing reintervention risk.