Cirugía coronaria: veinte años de seguimiento / Results of coronary surgery: a 20 years experience

RESUMO

Background: Since the first surgical coronary revascularization done in Chile in 1971, 5000 such procedures bave been performed. Aim: To assess the long term results of coronary revascularization surgery in our institution and to identify prognostic factors. Patients and methods: Five groups of 100 patients each, composed by the first consecutive patients subjected exclusively to coronary bypass surgery in the years 1975, 1980, 1985, 1990 and 1995 were retrospectively studied. Results: Mean age of Patients increased from a median of 52 years old in 1975 to 62 yean old in 1995. No changes in the frequency of diabetes, hypertension, high serum cholesterol or prvious mycardial infarction were observed. There was an increase in the Proportion of patients with a recent (< 30 days) infarction that were operated along time. Seventy percent of patients had triple vessel disease or LMT and this proportion did not change. The number of grafts per patients increased form 1.9 to 3.4 and the use of arterial conduits from 0.18 to 0.81. Perioperative mortality remained constant and was 1.6 percent. Follow up information was obtained for 93 percent of 492 survivors. Actuarial survival at 5, 10, 15 and 20 years was 93ñ1, 82ñ2, 62ñ3 and 41ñ4 percent respectively. Ninety eight ñO.7, 89ñ2, 73ñ4 and 65ñ5 percent of patients remained free of a new myocardial infarction in the same lapses, respectively. Ninety seven ñl, 94ñ2, 76ñ4 and 47ñ7 percent of patients remained free of a new operation. Stepwise logistical regression analysis identified as bad Prognostic factors, in decreasing order: cardiac failure, diabetes, smoking, hypercholesterolemia and age at the moment of operation. Conclusions: Coronary artery bypass surgery provides good and long lasting clinical improvement. The prognosis of patients is influenced by the presence of cardiac failure, some well known coronary risk factors and age at the moment of operation