The changing mortality of myocardial revascularization: Coronary artery bypass and angioplasty

The risk factors and outcome for the first 150 consecutive patients undergoing coronary artery bypass grafting (CABG) in 1985 (CABG ʹ85) were compared with those of the first 150 patients undergoing CABG in 1975 (CABG ʹ75) and those of the first 150 patients to have percutaneous transluminal coronary angioplasty (PTCA) in 1985 (PTCA ʹ85). The CABG ʹ85 patients had a significantly higher (p < 0.05) incidence of known operative risk factors including advanced age, female sex, severity of angina, history of recent infarction, triple-vessel disease, left ventricular dysfunction, and emergency operation than the CABG ʹ75 cohort. The clinical profile of the PTCA ʹ85 patients closely resembled the low-risk profile found in the CABG ʹ75 patients. Overall mortality following CABG more than doubled during the decade studied (3% versus 7%, p = 0.07). This study suggests that the increased mortality associated with CABG in 1985 is due in part to the inclusion of more high-risk patients in the surgical population. In addition, the application of PTCA removes low-risk patients from the surgical candidate pool and adds more patients requiring emergency operations, thereby further contributing to the overall decline in the clinical status of patients referred for operation.