THE CHANGING CLINICAL PROFILE OF CORONARY-ARTERY BYPASS GRAFT PATIENTS, 1970-89

OBJECTIVE: To review the changing clinical profile of isolated coronar y artery bypass graft (CABG) surgery patients at the University of Alb erta Hospitals during the past two decades. DESIGN: Data were obtained retrospectively by review of patients' hospital charts and cardiologi sts' charts. The three patient cohorts consisted of the first 411 cons ecutive patients who underwent isolated CABG surgery between 1970 and 1974, 302 consecutive patients who had CABG surgery in 1984 and 346 co nsecutive patients who had the operation in 1989. RESULTS: Patients wh o underwent CABG surgery in 1984 and 1989 were older than patients und ergoing the same operation in the 1970s. Emergency and/or urgent opera tions and the number of patients with prior myocardial infarct were in creased significantly in 1984 and 1989. The incidence of patients with multiple vessel disease and left main stem stenosis increased signifi cantly over the two decades. The number of bypass grafts per patient a nd the use of internal mammary grafts have increased since 1970. The e ndarterectomy procedure was performed less frequently in 1984 and 1989 . The use of radial artery grafts has been discontinued. Perioperative mortality remained stable throughout the study period despite an incr easing incidence of high risk patients. The major cause of death was p ump failure. The incidence of peripostoperative myocardial infarct was higher in the 1970s. A multivariate analysis of the 1984 and 1989 coh orts was performed to identify temporal trends in risk factors. Emerge ncy surgery, preoperative heart failure, age (older than 65 years), pr ior CABG surgery and preoperative renal failure are significant predic tors of operative motility. CONCLUSIONS: The clinical profile of patie nts for isolated CABG surgery has changed over the years. The mortalit y rate has been stable over two decades despite the advancement of med ical and surgical practices, representing a balance of increasingly hi gh risk patients presenting for CABG surgery.