Mortality and morbidity surrounding coronary artery bypass surgery and the public presentation of risk

• coronary artery bypass

Deaths of patients on the waiting list for coronary artery bypass surgery are often presented by the media to the public and politicians as evidence of the remediable failure of health care.1 The assumption that many lives would be saved by more timely intervention is over-simplistic and takes no account of three important observations. Firstly, for approximately one third of low risk patients the principal reason for performing coronary artery bypass procedures is for the relief of angina, rather than mortality prevention.2 Secondly, people on waiting lists inevitably have widespread vascular disease and the atherosclerotic lesions that cause sudden death may not be the same as those for which the patient has been listed for relief of angina.3 Lastly, operative death rates for elective surgery of 1%–2%4 mean a proportion of patients die as a result of the procedure itself.

We have compared the mortality and myocardial infarction risk of those waiting for coronary artery bypass surgery with those undergoing this procedure using routine and published data. The aim is to estimate the numbers of deaths and myocardial infarctions in each time period to determine whether, at a population level, the frequent attention drawn to adverse events while on a waiting list should be more equally balanced by consideration of the risk of perioperative and postoperative adverse events.