Long-term Beneficial Effect of Coronary Artery Bypass Grafting in Patients with COPD

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.