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The Annals of Thoracic Surgery, Vol 40, 245-260, Copyright © 1985 by The Society of Thoracic Surgeons
WO Myers, K Davis, ED Foster, C Maynard and GC Kaiser
The overall surgical survival data in the Coronary Artery Surgery Study
(CASS) registry have not been published to date, pending the report of the
randomized medical-surgical comparison (CASS randomized trial). Non-
randomized surgical survival data from the CASS registry are given in this
article. The overall medical survival data from the registry were reported
previously as a natural history study. There were 8,991 patients in the
registry portion of CASS who had primary isolated coronary artery bypass
grafting and 8,971 with follow-up of more than 30 days. The 5-year survival
for all 8,971 patients was 90%, and the operative mortality was 2.37%.
Patients with left main coronary artery disease had an operative mortality
of 3.84% and a 5-year survival of 85%, while patients with lesions in other
vessels had an operative mortality of 2.12% and a 5-year survival of 91%.
Among patients without left main coronary disease, the 5-year survival was
93% in those with single-vessel and 92% in those with double-vessel disease
(operative mortality was 1.50% and 1.92%, respectively) and 88% in patients
with triple-vessel disease (operative mortality was 2.62%; p = 0.009). When
results for patients with left main coronary artery obstruction were
compared with those for triple-vessel disease, the 5-year survival figures
were 85% and 88%, respectively (p = 0.02) and the operative mortality,
3.84% and 2.62%, respectively (p = 0.03). Patients with normal or nearly
normal left ventricular (LV) function (i.e., LV segmental wall motion
scores ranging from 5 through 11) had a 5-year survival of 92% and an
operative mortality of 1.97%. Patients with moderate impairment (LV score
range, 12 through 16) had a 5-year survival of 80% and an operative
mortality of 4.21%. In those with poor ventricular function (LV score of 17
or greater), the 5-year survival was 65% and the operative mortality was
6.21%. The difference in survival among the three groups was significant (p
less than 0.0001). Of 29 variables used in a stepwise Cox regression
analysis, LV wall motion score, congestive heart failure score, age, number
of operable vessels, smoking history, LV end-diastolic pressure, and
percent of left main coronary artery stenosis were found to have a
significant effect on long-term survival (excluding 30-day mortality), and
these variables plus surgical priority and height influenced surgical
mortality. When height was used in the Cox proportional hazards model,
female sex was no longer a significant variable.
ARTICLES
Surgical survival in the Coronary Artery Surgery Study (CASS) registry
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