Background: Since the introduction of coronary artery bypass grafting (CABG) in 1964 and percutaneous coronary intervention (PCI) with balloon angioplasty in 1977 these complementary strategies of revascularization for coronary artery disease has undergone rapid progress and have been used extensively.
Purpose: To evaluate the long-term clinical outcome of the first patients treated by PCI or venous CABG at a single centre that had reached a life-cycle follow-up after 40 years.
Methods: We analysed the outcome of the first elective consecutive patients who underwent PCI (n=856) between 1980–1985 and venous CABG (n=1041) from 1971 to 1980. Routine follow-up assessment was obtained via reviewing hospital, general practitioner records, the civil registry or by telephone interviews at 12 months after the procedures, and every 5–7 years thereafter. Follow-up was successfully achieved in 98% (median 32 years, range 31–35) after PCI and in 98% patients (median 38 years, range 36–45) underwent CABG.
Results: In patients undergoing PCI, the median age was 56 [interquartile range (IQR) 50–63], 80% were male and 12% had a history of diabetes. Patients in the CABG cohort had a median age of 53 (IQR 48–58), 88% were male and diabetes was present in 8%. A total of 37% of patients in the PTCA group and 82% of those in the CABG group had multivessel coronary disease. The cumulative survival rates at 10-, 20-, 30- and 34-year were 78%, 47%, 21% and 13%, after PTCA and 77%, 39%, 14%, and 4% (40-year) after CABG (Figure). During follow-up, repeat revascularization was performed in 58% after PTCA and 36% after CABG while freedom from death or re-intervention observed in 5% PTCA and 2% CABG patients (Figure). Overall life-expectancy was 17 years after first PTCA and 18 years after first CABG procedure.
Conclusions: This life-cycle analysis demonstrates that both PCI and CABG were excellent treatment options immediately after their introduction. They functioned as a lifesaving procedure while indirectly they enabled patients to be treated with newly developed procedures and medication strategies during follow-up.