TY - JOUR
T1 - Repeat coronary revascularization after coronary artery bypass surgery in older adults
T2 - the Society of Thoracic Surgeons' national experience, 1991-2007
AU - Fosbøl, Emil L
AU - Zhao, Yue
AU - Shahian, David M
AU - Grover, Frederick L
AU - Edwards, Fred H
AU - Peterson, Eric D
PY - 2013/4/23
Y1 - 2013/4/23
N2 - BACKGROUND: A major advantage of coronary artery bypass graft surgery (CABG) relative to percutaneous coronary intervention is its durability, yet there is a paucity of information on rates and predictors of repeat coronary revascularization after CABG in the modern era.METHODS AND RESULTS: We included patients ≥65 years from the Society of Thoracic Surgeons' National Adult Cardiac Surgery Database who were undergoing first-time isolated CABG from 1991 to 2007 (n=723 134, median age 73 years). After linking to Medicare claims data, long-term outcomes of CABG (up to 18 years after surgery) were examined by use of cumulative incidence curves. Multivariable Cox proportional hazard analysis was used to identify factors associated with 1- and 5-year repeat revascularization trends and variability. We found that the overall 18-year survival rate was 20%. Cumulative incidences of any repeat revascularization (percutaneous coronary intervention or CABG, yet most often percutaneous coronary intervention) were 2%, 7%, 13%, and 16% at 1, 5, 10, and 18 years after surgery, respectively. The rates of repeat CABG procedures were quite low for all time points (0.1%, 0.6%, 1.3%, and 1.7%, respectively). Female sex, disease severity represented by a history of percutaneous coronary intervention, preoperative dialysis, and partial revascularization were strongly associated with a higher revascularization rate, whereas advanced age, left main disease, and smoking were associated with a lower rate. There was approximately a 2-fold variation in repeat revascularization rates across centers at 1 year (interquartile range 1.7-3.6%) and 5 years (interquartile range 6.7-12.0%).CONCLUSIONS: Repeat revascularization is performed infrequently among older patients who undergo CABG; however, these rates vary substantially by patient subgroups and among providers.
AB - BACKGROUND: A major advantage of coronary artery bypass graft surgery (CABG) relative to percutaneous coronary intervention is its durability, yet there is a paucity of information on rates and predictors of repeat coronary revascularization after CABG in the modern era.METHODS AND RESULTS: We included patients ≥65 years from the Society of Thoracic Surgeons' National Adult Cardiac Surgery Database who were undergoing first-time isolated CABG from 1991 to 2007 (n=723 134, median age 73 years). After linking to Medicare claims data, long-term outcomes of CABG (up to 18 years after surgery) were examined by use of cumulative incidence curves. Multivariable Cox proportional hazard analysis was used to identify factors associated with 1- and 5-year repeat revascularization trends and variability. We found that the overall 18-year survival rate was 20%. Cumulative incidences of any repeat revascularization (percutaneous coronary intervention or CABG, yet most often percutaneous coronary intervention) were 2%, 7%, 13%, and 16% at 1, 5, 10, and 18 years after surgery, respectively. The rates of repeat CABG procedures were quite low for all time points (0.1%, 0.6%, 1.3%, and 1.7%, respectively). Female sex, disease severity represented by a history of percutaneous coronary intervention, preoperative dialysis, and partial revascularization were strongly associated with a higher revascularization rate, whereas advanced age, left main disease, and smoking were associated with a lower rate. There was approximately a 2-fold variation in repeat revascularization rates across centers at 1 year (interquartile range 1.7-3.6%) and 5 years (interquartile range 6.7-12.0%).CONCLUSIONS: Repeat revascularization is performed infrequently among older patients who undergo CABG; however, these rates vary substantially by patient subgroups and among providers.
KW - Age Factors
KW - Aged
KW - Aged, 80 and over
KW - Comorbidity
KW - Coronary Artery Bypass/statistics & numerical data
KW - Coronary Restenosis/surgery
KW - Databases, Factual/statistics & numerical data
KW - Female
KW - Humans
KW - Incidence
KW - Kidney Diseases/epidemiology
KW - Male
KW - Medicaid/statistics & numerical data
KW - Medicare/statistics & numerical data
KW - Obesity/epidemiology
KW - Percutaneous Coronary Intervention/statistics & numerical data
KW - Postoperative Complications/mortality
KW - Proportional Hazards Models
KW - Renal Dialysis/statistics & numerical data
KW - Reoperation/statistics & numerical data
KW - Retrospective Studies
KW - Risk Factors
KW - Smoking/epidemiology
KW - Societies, Medical
KW - Survival Rate
KW - Thoracic Surgery
KW - United States/epidemiology
U2 - 10.1161/CIRCULATIONAHA.113.001882
DO - 10.1161/CIRCULATIONAHA.113.001882
M3 - Journal article
C2 - 23532630
SN - 1524-4539
VL - 127
SP - 1656
EP - 1663
JO - Circulation
JF - Circulation
IS - 16
ER -