Long-term Outcomes of Coronary Artery Bypass Grafting in Veterans with Left Main Coronary Artery Disease

Abstract

Background: Studies of the civilian population with left main coronary artery disease (LMCAD) who underwent coronary artery bypass grafting (CABG) have shown 2% to 4.2% 30-day mortality. However, there is a lack of reporting from the veteran population. Here we analyze the outcomes of veterans with LMCAD who underwent CABG by a single surgeon at a single Veterans Affairs Medical Center (VAMC). Methods: Veterans who underwent isolated CABG between 1998 to 2018 at a VAMC were further divided into a group with significant left main coronary artery disease (LMCAD) of stenosis greater than or equal to 50% and a group without left main coronary artery stenosis (non-LMCAD). The primary outcome was mortality. Secondary outcomes included postoperative complications. Multivariable regression analysis and Kaplan-Meier survival analysis were used to compare the two cohorts. Results: The demographics and comorbidities are similar between the two cohorts except for higher average age and percentage of stroke in the LMCAD group (n = 509) compared to non-LMCAD (n = 927). Perioperative complications are comparable between the two groups except for increased length of stay (LOS) in the LMCAD group (12.9 ± 15.9 days versus 10.9 ± 9.0 days in non-LMCAD, P < .001). 30-day mortality in the LMCAD group is 4.1% versus 1.4% in non-LMCAD. However, Kaplan-Meier curves show no significant difference in adjusted overall survival throughout 15 years between the groups (P = .560). Conclusion: Veterans with LMCAD who underwent CABG have similar postoperative complications compared to non-LMCAD group. The 30-day mortality is higher in the LMCAD group; however, there is no difference in long-term survival.