Results Of Coronary Artery Bypass Surgery on Survival:

Overview of 10-year Results from Randomized Trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration

Salim Yusuf, David Zucker, Peter Peduzzi, et al

The Lancet. August 27, 1994;344(8922):563-570.

Approximate 2650 patients with angina pectoris from coronary heart disease were randomized into two equal groups. Half underwent coronary artery bypass graft (CABG) surgery and half had no surgery and were treated medically. They were followed for 12 years. Overall results, as graphed below, showed that surgical patients had an increased death rate for the first year, because of surgical complications. Surgery did not decrease death rate until after the second year. At the 5^th year 15.5% of non-surgical patients had died compared with 10.2% of bypass patients. In other words, there was only a 5.6% reduction in death rate in surgical versus non-surgical patients at the time of maximum benefit, and a 3% to 5% rate of immediate deaths from surgical complications of bypass. Although this shows a statistically significant surgical benefit, it is a narrow margin with which to push bypass surgery onto patients. None of the patients received chelation therapy. It is quite possible that if the non-surgical patients had received chelation therapy, the small comparative benefit from surgery would have disappeared.

 

The graph above, as published in The Lancet,  shows the cumulative death rate of patients in the two studied groups during 12 years of observation. The Y-axis is cumulative death rate and the  X-axis is years into the study. The upper curve (in red) represents 1325 patients who were treated without bypass surgery (medical treatment), and who had a slightly higher death rate from the 2^nd through 12^th year (15.8% dead at 5 years vs 10.2% of bypass patients). The 1324  patients treated with bypass surgery had a higher death rate during the first year caused by surgical complications, after which the curves cross. By the 12th year the percentage of survivors in each group was about equal.

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