M. Haraphongse et al., THE CHANGING CLINICAL PROFILE OF CORONARY-ARTERY BYPASS GRAFT PATIENTS, 1970-89, Canadian journal of cardiology, 10(1), 1994, pp. 71-76
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.