Long-term (15 year) outcome after myocardial revascularization by PTCA or CABG: What have we learned?

Knowledge of the long-term outcomes after revascularization is relevant to current clinical decisions involving patient management. Patients revascularized by balloon angioplasty (PTCA) or coronary bypass surgery (CABG) in 1984-1986 in one referral center were entered into a revascularization registry and followed for survival and recurrent events. Estimated 15 year survival (Kaplan-Meier) was similar for patients with multivessel disease treated by CABG or PTCA both overall and in various sub-groups studied including patients with diabetes mellitus. Diabetes mellitus and 3 vessel disease at baseline but not the initial revascularization procedure were independent predictors of poor overall survival. Repeat revascularization was more common after PTCA but the annual rate of repeat revascularization was similar at 9-12 years after the index procedure. Heart failure was a prominent cause of demise in diabetic patients. Analysis of the long-term outcomes of patients revascularized 15 years ago continues to be relevant to clinical decisions at the present time.