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Long-term Beneficial Effect of Coronary Artery Bypass Grafting in Patients With COPD^*

^* From the Department of Cardiothoracic Surgery, The Edith Wolfson Medical Center, Holon, Israel.

Correspondence to: Benjamin Medalion, MD, Department of Cardiothoracic Surgery, The Edith Wolfson Medical Center, POB 5, Holon, 58100, Israel; e-mail: medalion{at}wolfson.health.gov.il

Objective: This study assesses the impact of COPD on the long-term outcome of patients undergoing coronary artery bypass grafting (CABG).

Methods: Between 1991 and 1993, 37 patients (5.68%) undergoing CABG had significant clinical COPD. They were compared to 37 matched control subjects.

Results: The patients in the COPD group had worse preoperative pulmonary function. More patients in this group were smokers, had more symptoms of shortness of breath, and had more preoperative arrhythmia. A total of 13 patients died in the COPD group compared with 3 subjects in the control group during 8.6 ± 2 years (mean ± SD) of follow-up with arrhythmia being the major cause of death (62%). Actuarial survival at 9 years was 92% for the control group vs 65% for the COPD group (p = 0.005). The rate of readmissions during mid-term follow-up (13.8 ± 7.2 months) was higher in the COPD group, and more patients in this group described their quality of life as worse than before the operation (37% vs 3%, p < 0.001). At late follow-up, all survivors in the COPD group had an improved quality of life. Cox regression analysis identified older age and lower FEV₁ as independent predictors of late death. Pulmonary function returned to baseline in the control group and improved to above baseline in the patients with COPD.

Conclusions: Patients with significant COPD have a higher risk after CABG compared to patients without COPD. Nevertheless, when assessing the natural history of patients with COPD, it seems those who undergo CABG benefit from the operation.

Key Words: COPD • coronary artery bypass grafting • myocardial revascularization

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