• Rodolfo V Rocha, Terrence M Yau, Anna Chu, Douglas S Lee, Maral Ouzounian, and Vivek Rao.
• Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
• J. Thorac. Cardiovasc. Surg. 2024 Sep 25.

ObjectiveFew have examined the impact of early adverse events post coronary artery bypass grafting (CABG) on long-term survival. We sought to determine if the occurrence of non-fatal major adverse cardiac and cerebrovascular events (MACCE) in the first 5 years after CABG impacts survival and adverse events at 10 years.MethodsAll patients who underwent isolated CABG from 1990-2014 at a single center in Ontario, Canada were included. Primary endpoint was all-cause mortality. The secondary endpoint of interest was MACCE, a composite of mortality, non-fatal myocardial infarction, stroke, and repeat revascularization.Results20,444 cases of elective primary isolated CABG were identified as being alive at 5-years, with 11% patients developing non-fatal MACCE within the first 5 years post CABG (MACCE group) and the remaining 89% were alive without a MACCE event at 5-years (non-MACCE group). Following propensity score matching, 2,167 patient-pairs were formed. Among the MACCE group, 972/2,167 (44.9%) developed an MI, 519/2,167 (24.0%) had a stroke, and 946/2,167 (43.7%) required a repeat revascularization within the first 5 years post CABG. Non-MACCE was associated with better overall survival (HR 1.42 [95% confidence interval (CI) 1.25-1.63], p<0.01) and freedom from MACCE (HR 1.61 [95% CI 1.45-1.79], p<0.01) up to 10-years post CABG compared to MACCE cases.ConclusionsPatients who experienced non-fatal MACCE in the first 5-year after CABG experienced worse survival and more MACCE at 10 years. Prevention of major adverse events in the first five years after surgical revascularization may be an important strategy to improve late outcomes.Copyright © 2024. Published by Elsevier Inc.

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