IMPACT OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY ON CORONARY-BYPASS SURGERY - CHANGES IN THE PATIENT PROFILE DURING THE PAST DECADE

As percutaneous transluminal coronary angioplasty has become an increa singly common procedure replacing coronary artery bypass grafting (CAB G), the clinical profile of the patients referred for CABG has changed markedly, A retrospective study of the changes in the clinical profil e and surgical outcome of patients who underwent CABG during the past 10 years was conducted. Between March 1982 and February 1996, 1010 pat ients underwent isolated CABG at Nara Medical University. The first 10 0 consecutive patients who underwent CABG in 1984-85 (group 1) were co mpared with the first 100 consecutive patients who underwent CABG in 1 994-95 (group 2). Preoperative risk increased significantly during the decade with respect to patient age (p<0.001), the presence of diabete s mellitus (p=0.048), the number of diseased vessels (p<0.001), left m ain trunk disease (p=0.008), the presence of aortic or peripheral vasc ular disease (p=0.032),and the need for emergency surgery (p=0.013). O perative procedures have become more complicated with respect to the n umber of total and arterial grafts, duration of the aortic cross-clamp and cardiopulmonary bypass. Hospital mortality for elective CABG has not changed (2%) and the overall mortality has not increased significa ntly (from 2% to 3%) during the decade. In conclusion, although the pr eoperative risks have increased and more complicated procedures are re quired, CABG continues to be performed safely with low mortality rates .