Reasons for Coronary Artery Bypass Graft Rejection: Patients’ and Surgeons’ Perspectives

Abstract

Background: Studies have shown improved outcomes following coronary artery bypass grafting (CABG) as compared to percutaneous coronary intervention (PCI) in patients who have left main or multivessel disease or diabetes with concomitant multivessel disease. However, there are various factors influencing the patient’s decision to have surgery. This study aims to elucidate the reasons why some patients with indications for the procedure do not eventually receive CABG. Methods: Cases from a single tertiary referral centre were retrospectively examined and indicated patients who did not undergo CABG were included in this study. The main reasons for not undergoing CABG were identified and classified into sub-themes. The risk of CABG quoted by surgeons during surgical consultation was categorised into high or non-high and compared against the patient’s EuroSCORE II. Subjective risk perception was compared with objective measurements to evaluate if subjective risk perception correlated with objective measurements. Results: A total of 301 cases were reviewed and 127 cases were finally included. Patient choice was the most common reason for not undergoing CABG, followed by surgical reasons, then medical reasons. The most common sub-theme of reasons to not proceed given by patients was fear of the procedure (52%), followed by age (15%). The most common surgeon subtheme was perceived high risk for stroke or mortality (59%). Among the patients quoted as being at high risk by surgeons, only 6% had a high EuroSCORE II and 71% had a low EuroSCORE II. Conclusion: Pertinent patient and surgical reasons for declining CABG were identified. Identifying the reasons why patients indicated for CABG declined the procedure can inform and guide patient counselling. The disparity between subjective and objective risk scores suggests that surgeons’ estimation of risk incorporates factors not captured in objective risk scores, which is an area for future studies.