The paradox of excellent long-term survival and physical fitness after coronary artery bypass surgery despite suboptimal secondary prevention

Abstract

To evaluate current lifestyle, secondary medical prevention and objective physical abilities in long-term survivors after coronary artery bypass grafting (CAGB). Data were collected by written questionnaires and telephone interviews in 476 (405 men, mean age 56 years) patients after a median follow-up of 16.6 yrs (95% CI 16.5–16.7 yrs post-CABG). Triple-vessel coronary heart disease (CHD) was present in 56%; combined arterial and venous revascularization was performed in 21% of patients and 83% received complete revascularization. All patients are today under continuous medical therapy (1–10 drugs, mean 3.8±0.08) and the majority of patients (49%) undergo daily administration of 3–4 drugs. Present cardiovascular risk profiles include overweight (52% with a BMI of >25 kg/m2), arterial hypertension (44%), hyperlipidemia (66%, of whom 22% are without lipid-lowering therapy) and diabetes (21%, of whom 27% are without glucose-lowering therapy). Seventy-three percent of patients are today in NYHA class I or II. Angina or dyspnea during stress affect 35% and 47% of patients, respectively. Mean ergometric stress testing level was 107±3 W and 43% of patients were found to perform at >100 W. Acute myocardial infarction re-occurred in 26% and ≥1 occluded graft was found in 24% of patients; the frequency of re-CABG was 21% after a mean of 11±0.4 yrs. Long-term survivors after CABG procedure show excellent clinical conditions and physical abilities despite suboptimal secondary prevention of CHD in medial therapy and lifestyle issues. The cause(s) of the fortunate outcome in this “highly responsive” group remain to be illuminated.