Cardiac factors predictive of 10 year survival after coronary artery surgery.

Although the predictive factors of postoperative mortality after coronary a rtery surgery are well known, those predictive of long-term survival have r eceived less attention. This study reviews the outcome of a group of 480 pa tients between 50 and 65 years of age, operated between 1984 and 1986. The patients were classified in two groups according to the presence or abs ence of internal mammary artery bypass grafts : Group I (304 patients with saphenous vein bypass grafts alone) and group II (176 patients with an inte rnal mammary artery +/- saphenous vein bypass grafts). The long-term result s were assessed according to 3 criteria : isolated cardiac mortality : card iac mortality associated with a repeat revascularisation procedure and card iac mortality associated with reoperation or recurrence of angina. Cardiac survival at 10 years was significantly better after internal mammar y-LAD bypass : 91.4% (CI 87.1-95.1) than after saphenous vein bypass grafti ng alone : 79.6% (CI 74.8-84.4) (p= 0.012). Univariate analysis identified the following poor predictive factors : three vessel disease (p= 0.03), pre operative left ventricular dysfunction with an ejection fraction inferior t o 45% (p= 0.0001), incomplete revascularisation (p= 0.0003), use of venous bypass graft alone (p< 0.014) and perioperative infarction (p= 0.0254). For each criterion of survival (cardiac isolated or associated with a new reva scularisation and/or recurrence of angina), multivariate analysis identifie d three independant predictive factors of long-term extramortality : not us ing internal mammary artery-LAD bypass graft, incomplete revascularisation and preoperative hypertension. This study confirms the beneficial effects of internal mammary-LAD artery g rafting on long-term survival after coronary artery surgery, and also demon strates the prejudicial effects of hypertension.