Improving outcomes after coronary artery bypass surgery: lessons from indigenous australians.

摘要

Over the years, many of us have heard patients being told "after your bypass you will never have angina again". Certainly, the patients themselves consider coronary artery bypass grafting (CABG) to be a cure for their disease. These concepts are, unfortunately, false, yet they can distort the management of atherosclerotic vascular disease and impede vital secondary prevention measures. Even in the modern era, patients undergoing CABG have a significant subsequent mortality rate. Two major recent trials illustrate this issue. The SYNTAX trial documented an 11.4% mortality rate (all cause death) at five years after randomisation to CABG [1] and the FREEDOM trial documented a similar all-cause mortality of 10.9% at five years after CABG with a cardiac mortality of 6.8% [2]. It is recognised that some patient groups, such as those with diabetes, fare worse than others. In this issue of the Journal, Prabhu et al. document poorer outcomes in Indigenous Australians than in the non-Indigenous group [3].