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J Thorac Cardiovasc Surg 2003;126:326-328
© 2003 The American Association for Thoracic Surgery

Editorial

Does size matter? What is your infarct rate after coronary artery bypass grafting?

^a Department of Surgery, University of Kentucky College of Medicine, Lexington, Ky, USA.

Received for publication February 11, 2003; accepted for publication March 4, 2003.

^* Address for reprints: Robert M. Mentzer, Jr, MD, Department of Surgery, University of Kentucky College of Medicine, 800 Rose St, MN-264, Lexington, KY 40536-0298, USA
mentzer@pop.uky.edu

Key Words: 17 • 30 • 31

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There is compelling evidence that the 30-day mortality rate after coronary artery bypass grafting (CABG) has been on the decrease over the past 10 years. This conclusion is based, in part, on data from 1991 to 2000 derived and analyzed from both a multisite national voluntary database and a Veterans Administration mandatory database.^1,2 In the voluntary database, changes in the patient risk profile and outcomes of more than 1 million patients undergoing isolated CABG procedures were analyzed. The results indicated that, over the past decade, patients undergoing CABG were increasingly older and had more comorbidities. This was associated with a 30% increase in the predicted relative risk for mortality, from 2.6% to 3.4%. Despite this increase in risk, however, there was a decrease in the risk-adjusted mortality rate, from 4.8% to 2.9%. A subset analysis of the Medicare-aged population revealed an even greater increase in the predicted mortality for this group of patients, from 3.3% to 4.4%. The observed operative mortality rates in patients 65 years and older, however, declined from 5.4% to 4.1%, a relative risk reduction of 24.1%. These findings suggest that we are providing superb care to patients with coronary artery disease amenable to surgical intervention.

Possible explanations for the decrease in the observed mortality rate despite an increase in the expected mortality rate over the past decade include the introduction of critical care pathways, surgical service lines, formation of cardiac surgical teams, technical improvements in cardiopulmonary bypass, introduction of new myocardial protection strategies and methodologies, "fast-track" management, and changes in selection criteria.² As a consequence, one might be inclined to believe that the mortality rate after CABG has finally reached an acceptable level. Obviously, this is not the case, for the only acceptable mortality after CABG is 0.0%. Moreover, these types of studies do not take . . . [Full Text of this Article]

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