Subscribe to RSS
DOI: 10.1055/a-2655-2479
Coronary Artery Bypass Grafting: A Review of Short- and Long-Term Outcomes
Funding None.

Abstract
Coronary artery bypass grafting (CABG) remains a cornerstone in the management of complex coronary artery disease (CAD), offering significant improvements in both survival and quality of life. This review evaluates the short- and long-term outcomes associated with CABG. Despite its benefits, CABG carries perioperative complications, including atrial fibrillation, acute kidney injury, stroke, and surgical site infection. While early mortality rates, including in-hospital and 30-day outcomes, are comparable to those observed with percutaneous coronary intervention (PCI), long-term data often favor CABG in specific patient populations. Multiple studies have demonstrated superior long-term survival with CABG over PCI in patients with multivessel disease, left main CAD, and comorbid conditions such as diabetes mellitus. Perioperative morbidity and mortality are significantly influenced by patient-specific risk factors, such as advanced age, female sex, reduced ejection fraction, and elevated biomarkers (e.g., troponin, NT-proBNP, C-reactive protein). Since its introduction in the 1960s, CABG techniques have evolved with off-pump and minimally invasive approaches offering reduced hospital length of stay, shorter intensive care unit duration, and lower transfusion requirements, while maintaining comparable safety and efficacy to conventional on-pump surgery. In addition, graft selection is an important determinant of long-term success of CABG. In conclusion, CABG continues to be a highly effective revascularization strategy. Surgical technique, graft type, and careful patient selection remain essential to optimizing both perioperative safety and long-term outcome.
Keywords
coronary artery bypass grafting - coronary artery disease - surgical outcomes - perioperative complications - graft patency - long-term survival - postoperative mortalityPublication History
Article published online:
29 July 2025
© 2025. International College of Angiology. This article is published by Thieme.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Młynarska E, Czarnik W, Fularski P. et al. From atherosclerotic plaque to myocardial infarction-the leading cause of coronary artery occlusion. Int J Mol Sci 2024; 25 (13) 7295
- 2 Bakaeen FG, Chu D, Kelly RF, Holman WL, Jessen ME, Ward HB. Perioperative outcomes after on- and off-pump coronary artery bypass grafting. Tex Heart Inst J 2014; 41 (02) 144-151
- 3 Serruys PW, Revaiah PC, Ninomiya K. et al. 10 years of SYNTAX: closing an era of clinical research after identifying new outcome determinants. JACC Asia 2023; 3 (03) 409-430
- 4 Farkouh ME, Domanski M, Sleeper LA. et al; FREEDOM Trial Investigators. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med 2012; 367 (25) 2375-2384
- 5 Farkouh ME, Domanski M, Dangas GD. et al; FREEDOM Follow-On Study Investigators. Long-term survival following multivessel revascularization in patients with diabetes: the FREEDOM Follow-On Study. J Am Coll Cardiol 2019; 73 (06) 629-638
- 6 Weintraub WS, Grau-Sepulveda MV, Weiss JM. et al. Comparative effectiveness of revascularization strategies. N Engl J Med 2012; 366 (16) 1467-1476
- 7 Ahn JM, Kang DY, Yun SC. et al; BEST Extended Follow-Up Study Investigators. Everolimus-eluting stents or bypass surgery for multivessel coronary artery disease: extended follow-up outcomes of multicenter randomized controlled BEST trial. Circulation 2022; 146 (21) 1581-1590
- 8 Park SJ, Ahn JM, Kim YH. et al; BEST Trial Investigators. Trial of everolimus-eluting stents or bypass surgery for coronary disease. N Engl J Med 2015; 372 (13) 1204-1212
- 9 Holm NR, Mäkikallio T, Lindsay MM. et al; NOBLE investigators. Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial. Lancet 2020; 395 (10219): 191-199
- 10 Fearon WF, Zimmermann FM, De Bruyne B. et al; FAME 3 Investigators. Fractional flow reserve-guided PCI as compared with coronary bypass surgery. N Engl J Med 2022; 386 (02) 128-137
- 11 Rocha EAV. Fifty years of coronary artery bypass graft surgery. Braz J Cardiovasc Surg 2017; 32 (04) II-III
- 12 Sun LY, Tu JV, Bader Eddeen A, Liu PP. Prevalence and long-term survival after coronary artery bypass grafting in women and men with heart failure and preserved versus reduced ejection fraction. J Am Heart Assoc 2018; 7 (12) e008902
- 13 Hällberg V, Palomäki A, Lahtela J, Voutilainen S, Tarkka M, Kataja M. Study Group (W-CABG). Associations of metabolic syndrome and diabetes mellitus with 16-year survival after CABG. Cardiovasc Diabetol 2014; 13 (01) 25
- 14 Thielmann M, Sharma V, Al-Attar N. et al. ESC Joint Working Groups on Cardiovascular Surgery and the Cellular Biology of the Heart Position Paper: perioperative myocardial injury and infarction in patients undergoing coronary artery bypass graft surgery. Eur Heart J 2017; 38 (31) 2392-2407
- 15 Brown JR, MacKenzie TA, Dacey LJ. et al; Northern New England Cardiovascular Disease Study Group. Using biomarkers to improve the preoperative prediction of death in coronary artery bypass graft patients. J Extra Corpor Technol 2010; 42 (04) 293-300
- 16 Schachner T, Wiedemann D, Fetz H, Laufer G, Kocher A, Bonaros N. Influence of preoperative serum N-terminal pro-brain type natriuretic peptide on the postoperative outcome and survival rates of coronary artery bypass patients. Clinics (Sao Paulo) 2010; 65 (12) 1239-1245
- 17 van Straten AHM, Soliman Hamad MA, van Zundert AJ, Martens EJ, Schönberger JPAM, de Wolf AM. Preoperative C-reactive protein levels to predict early and late mortalities after coronary artery bypass surgery: eight years of follow-up. J Thorac Cardiovasc Surg 2009; 138 (04) 954-958
- 18 Dumitriu LaGrange D, Tessitore E, Reymond P, Mach F, Huber C. A systematic review and meta-analysis of differences between men and women in short-term outcomes following coronary artery bypass graft surgery. Sci Rep 2024; 14 (01) 20682
- 19 Caliskan E, Güsewell S, Seifert B. et al. Does body mass index impact the early outcome of surgical revascularization? A comparison between off-pump and on-pump coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2014; 19 (05) 749-755
- 20 Shekar PS. Cardiology patient page. On-pump and off-pump coronary artery bypass grafting. Circulation 2006; 113 (04) e51-e52
- 21 Lamy A, Devereaux PJ, Prabhakaran D. et al; CORONARY Investigators. Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting. N Engl J Med 2016; 375 (24) 2359-2368
- 22 Lamy A, Devereaux PJ, Prabhakaran D. et al; CORONARY Investigators. Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med 2012; 366 (16) 1489-1497
- 23 Shroyer AL, Grover FL, Hattler B. et al; Veterans Affairs Randomized On/Off Bypass (ROOBY) Study Group. On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med 2009; 361 (19) 1827-1837
- 24 Diegeler A, Börgermann J, Kappert U. et al; GOPCABE Study Group. Off-pump versus on-pump coronary-artery bypass grafting in elderly patients. N Engl J Med 2013; 368 (13) 1189-1198
- 25 Raja SG, Garg S, Rochon M, Daley S, De Robertis F, Bahrami T. Short-term clinical outcomes and long-term survival of minimally invasive direct coronary artery bypass grafting. Ann Cardiothorac Surg 2018; 7 (05) 621-627
- 26 Teman NR, Hawkins RB, Charles EJ. et al; Investigators for the Virginia Cardiac Services Quality Initiative. Minimally invasive vs open coronary surgery: a multi-institutional analysis of cost and outcomes. Ann Thorac Surg 2021; 111 (05) 1478-1484
- 27 Birla R, Patel P, Aresu G, Asimakopoulos G. Minimally invasive direct coronary artery bypass versus off-pump coronary surgery through sternotomy. Ann R Coll Surg Engl 2013; 95 (07) 481-485
- 28 Vicol C, Nollert G, Mair H. et al. Midterm results of beating heart surgery in 1-vessel disease: minimally invasive direct coronary artery bypass versus off-pump coronary artery bypass with full sternotomy. Heart Surg Forum 2003; 6 (05) 341-344
- 29 Sharaf M, Zittermann A, Sunavsky J. et al. Early and late outcomes after minimally invasive direct coronary artery bypass vs. full sternotomy off-pump coronary artery bypass grafting. Front Cardiovasc Med 2024; 11: 1298466
- 30 Goldman S, Sethi GK, Holman W. et al. Radial artery grafts vs saphenous vein grafts in coronary artery bypass surgery: a randomized trial. JAMA 2011; 305 (02) 167-174
- 31 Tinica G, Chistol RO, Enache M, Leon Constantin MM, Ciocoiu M, Furnica C. Long-term graft patency after coronary artery bypass grafting: effects of morphological and pathophysiological factors. Anatol J Cardiol 2018; 20 (05) 275-282
- 32 Gaudino M, Benedetto U, Fremes S. et al; RADIAL Investigators. Radial-artery or saphenous-vein grafts in coronary-artery bypass surgery. N Engl J Med 2018; 378 (22) 2069-2077
- 33 Goldman S, Zadina K, Moritz T. et al; VA Cooperative Study Group #207/297/364. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol 2004; 44 (11) 2149-2156
- 34 Kim KM, Arghami A, Habib R. et al. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2022 update on outcomes and research. Ann Thorac Surg 2023; 115 (03) 566-574
- 35 Safaie N, Montazerghaem H, Jodati A, Maghamipour N. In-hospital complications of coronary artery bypass graft surgery in patients older than 70 years. J Cardiovasc Thorac Res 2015; 7 (02) 60-62
- 36 Jawitz OK, Gulack BC, Brennan JM. et al. Association of postoperative complications and outcomes following coronary artery bypass grafting. Am Heart J 2020; 222: 220-228
- 37 Arbel Y, Fuster V, Baber U, Hamza TH, Siami FS, Farkouh ME. Incidence, determinants and impact of acute kidney injury in patients with diabetes mellitus and multivessel disease undergoing coronary revascularization: Results from the FREEDOM trial. Int J Cardiol 2019; 293: 197-202
- 38 Serruys PW, Morice MC, Kappetein AP. et al; SYNTAX Investigators. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009; 360 (10) 961-972
- 39 Stone GW, Kappetein AP, Sabik JF. et al; EXCEL Trial Investigators. Five-year outcomes after PCI or CABG for left main coronary disease. N Engl J Med 2019; 381 (19) 1820-1830
- 40 Shawon MSR, Odutola M, Falster MO, Jorm LR. Patient and hospital factors associated with 30-day readmissions after coronary artery bypass graft (CABG) surgery: a systematic review and meta-analysis. J Cardiothorac Surg 2021; 16 (01) 172
- 41 Leviner DB, Zafrir B, Jaffe R, Saliba W, Flugelman MY, Sharoni E. Impact of modifiable risk factors on long-term outcomes after coronary artery bypass surgery. Thorac Cardiovasc Surg 2021; 69 (07) 592-598
- 42 Park DW, Ahn JM, Park H. et al; PRECOMBAT Investigators. Ten-year outcomes after drug-eluting stents versus coronary artery bypass grafting for left main coronary disease: extended follow-up of the PRECOMBAT trial. Circulation 2020; 141 (18) 1437-1446
- 43 Sabatine MS, Bergmark BA, Murphy SA. et al. Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis. Lancet 2021; 398 (10318): 2247-2257
- 44 Hochman JS, Anthopolos R, Reynolds HR. et al; ISCHEMIA-EXTEND Research Group. Survival after invasive or conservative management of stable coronary disease. Circulation 2023; 147 (01) 8-19
- 45 Navarese EP, Lansky AJ, Kereiakes DJ. et al. Cardiac mortality in patients randomised to elective coronary revascularisation plus medical therapy or medical therapy alone: a systematic review and meta-analysis. Eur Heart J 2021; 42 (45) 4638-4651
- 46 Velazquez EJ, Lee KL, Deja MA. et al; STICH Investigators. Coronary-artery bypass surgery in patients with left ventricular dysfunction. N Engl J Med 2011; 364 (17) 1607-1616
- 47 Velazquez EJ, Lee KL, Jones RH. et al; STICHES Investigators. Coronary-artery bypass surgery in patients with ischemic cardiomyopathy. N Engl J Med 2016; 374 (16) 1511-1520
- 48 Squiers JJ, Schaffer JM, Banwait JK, Ryan WH, Mack MJ, DiMaio JM. Long-term survival after on-pump and off-pump coronary artery bypass grafting. Ann Thorac Surg 2022; 113 (06) 1943-1952
- 49 Thuijs DJFM, Davierwala P, Milojevic M. et al; SYNTAX Extended Survival Investigators. Long-term survival after coronary bypass surgery with multiple versus single arterial grafts. Eur J Cardiothorac Surg 2022; 61 (04) 925-933
- 50 Abdallah MS, Wang K, Magnuson EA. et al; FREEDOM Trial Investigators. Quality of life after PCI vs CABG among patients with diabetes and multivessel coronary artery disease: a randomized clinical trial. JAMA 2013; 310 (15) 1581-1590
- 51 Baron SJ, Chinnakondepalli K, Magnuson EA. et al; EXCEL Investigators. Quality-of-life after everolimus-eluting stents or bypass surgery for left-main disease: results from the EXCEL trial. J Am Coll Cardiol 2017; 70 (25) 3113-3122
- 52 Bangalore S, Maron DJ, Stone GW, Hochman JS. Routine revascularization versus initial medical therapy for stable ischemic heart disease: a systematic review and meta-analysis of randomized trials. Circulation 2020; 142 (09) 841-857
- 53 Spertus JA, Jones PG, Maron DJ. et al; ISCHEMIA Research Group. Health-status outcomes with invasive or conservative care in coronary disease. N Engl J Med 2020; 382 (15) 1408-1419
- 54 Schmidt-RioValle J, Abu Ejheisheh M, Membrive-Jiménez MJ. et al. Quality of life after coronary artery bypass surgery: a systematic review and meta-analysis. Int J Environ Res Public Health 2020; 17 (22) 8439