Trends and Outcomes of Coronary Artery Bypass Grafting in the Netherlands 2005 – 2020: A Netherlands Heart Registration Registry-based Study

Purpose: 

The aim is to describe trends of isolated coronary artery bypass grafting (CABG) practice in the Netherlands from 2005-2020, with 30-day major adverse cardiac and cerebrovascular events (MACCE) and 5-year survival and freedom from coronary reintervention for 2014-2020.

Methods:

Adult patients receiving isolated CABG between 2005 – 2020 and registered in Netherlands Heart Registration were included. Trends in off-pump (OPCABG), on-pump CABG (ONCABG), and type of graft were analysed with linear regression. Casemix corrected 30-day MACCE (mortality, revascularisation, perioperative myocardial infarction, stroke) was analysed with logistic regression, and 5-year endpoints with Kaplan-Meier and Cox regression. 

Results:

No decrease in OPCABG (14% in 2005, 17% in 2020), p = 0.29, and an increase in total arterial CABG (17% in 2005, 28% in 2020, p = 0.001) with dominant practice for ONCABG with mixed grafting (65%) were found (n=120000). MACCE increased for venous ONCABG (p < 0.001), was reduced for arterial ONCABG (p = 0.002), mixed and venous OPCABG (p < 0.001 and p = 0.02), and not significantly reduced for arterial OPCABG (p = 0.23), n=49775. Longest 5-year survival times were for ONCABG with arterial grafting (95%), and shortest for ONCABG with venous grafting (78%), a significant difference between all CABG subtypes (p < 0.001). A significant increase in revascularisation was observed for all but arterial ONCABG (p = 0.09). 

Conclusion:

This is the first study to analyse Dutch national CABG practice. ONCABG total arterial grafting showed consistent good outcomes, but might be biased by OPCABG practice differences and missing data.