Improved survival after coronary artery surgery in patients with extensive coronary artery disease.

Survival in patients with ischemic heart disease is closely related to the extent of coronary artery obstruction as determined angiographically. One hundred forty-nine consecutive patients underwent coronary artery bypass surgery from November, 1971, to October, 1974. There were 2 late cardiac deaths, 1 late noncardiac death, and 1 hospital death, an operative mortality rate of 0.7 per cent and a total mortality rate of 2.7 per cent. Coronary angiograms were scored according to the method of Friesinger, Page, and Ross. Fifty-four per cent (80/149) had scores of 10 or greater. Cumulative survival was analyzed according to life-table techniques; in the 80 surgically managed patients with scores of 10 or greater, survival at 3 years was 98 per cent. Friesinger's 47 nonoperated patients with similar angiographic scores had a 3 year cumulative survival of 68 per cent. Although this study compares different groups, the surgical series was composed of older patients (mean age 52 as compared to 44 years), includes 22 patients operated on urgently for preinfarction angina pectoris, and includes 18 patients with abnormal ventricular function. These data suggest that coronary artery bypass surgery can favorably influence prognosis in patients with severe coronary artery disease.