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[Survival and causes of secondary mortality in patients undergoing coronary bypass. Comparison with a same age control population].

During 10 years, 867 patients in whom the same surgical team had performed coronary bypass were followed up regularly without any of them being lost sight of. Moreover, the cause of all deaths in this group could be determined fairly accurately. A comparison of mortality between these patients and an age-matched control population studied longitudinally, year after year, showed that the mortality rate in the surgical group was slightly higher than in the control group (84 vs 77). Conversely, when the operative mortality was discounted, it appeared that the patients who survived coronary bypass had a much better survival than the control population (47 vs 77). Without any doubt, the prognosis for life is improved by surgery. In particular, patients with three-vessel disease (58 per cent), tight stenosis of the common coronary artery (10-25 per cent) or altered ventricular ejection fraction (about 30 per cent) would probably have died without myocardial revascularization. However, this study produced a rather astonishing result: compared with the control population, the decrease of long-term mortality in patients who survived coronary bypass was due not only to the decrease of cardiovascular deaths (16 vs 24) but also of deaths due to cancer (15 vs 27) or to other causes (16 vs 26). This suggests that a more hygienic life and a correct medical follow-up contribute to a large extent to the long-term survival of these surgical patients.