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35. Influence of Patient Characteristics and Arterial Grafting on Freedom from Coronary Reoperation
Joseph F Sabik, III, Eugene H Blackstone, A. Marc Gillinov, Michael K Banbury, Nicholas G Smedira, Paul Lagos, Bruce W Lytle; Cleveland, OH
Objective:
Atherosclerosis is a progressive disease, and many patients who undergo CABG require repeat coronary intervention. We sought to identify patient characteristics and operative factors that predict the need for reoperative CABG.
Methods:
From 1971 to 1998, 26,927 patients underwent primary, isolated CABG and were followed systematically every 5 years. A multivariable time-related analysis was performed to model freedom from coronary reoperation and to identify patient and operative variables associated with occurrence of coronary reoperation.
Results:
Freedom from reoperative CABG was 99.6%, 98.1%, 93.0%, 84.1%, 79.7%, and 61.8% at 1, 5, 10, 15, 20, and 25 years, respectively. Risk of reoperation (hazard function) demonstrated a transient peak early after CABG, followed by a slow rise for as long as patients were followed. Patient variables that increased the occurrence of coronary reoperation included younger age (P<.0001), higher cholesterol (P<.0001) and triglyceride (P=.0003), levels, lower high-density lipoprotein (P=.0008), presence of diabetes mellitus (P<.0001) with incrementally increasing risk in diet, oral, and insulin-treated varieties, and more extensive coronary artery disease (P=.01). Increasing extent of arterial grafting performed at primary CABG decreased the risk of coronary reoperation (P<.0001) (Fig).
Conclusions:
Patient factors associated with atherosclerosis progression and choice of bypass conduit both influence the need for repeat CABG. Aggressive patient risk factor reduction and extensive arterial coronary revascularization at primary CABG should decrease coronary reoperations. 
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