Incomplete revascularization and long-term survival after coronary artery bypass surgery.

Autor: Benedetto U; Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom., Gaudino M; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, USA. Electronic address: mfg9004@med.cornell.edu., Di Franco A; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, USA., Caputo M; Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom., Ohmes LB; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, USA., Grau J; Division of Cardiac Surgery, Ottawa Heart Institute, Ottawa, Canada., Glineur D; Division of Cardiac Surgery, Ottawa Heart Institute, Ottawa, Canada., Girardi LN; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, USA., Angelini GD; Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2018 Mar 01; Vol. 254, pp. 59-63. Date of Electronic Publication: 2018 Jan 28.
DOI: 10.1016/j.ijcard.2017.08.005
Abstrakt: Background: We sought to investigate the impact of incomplete revascularization (IR) on long-term survival after isolated coronary artery bypass grafting (CABG). The possible interaction between IR and off-pump surgery was also explored.
Methods: A total of 13,701 patients with multivessel disease undergoing CABG were included in the analysis. All patients received left internal thoracic artery (LITA) to the left anterior descending artery (LAD) territory. IR was defined as at least one diseased arterial territory (right coronary artery [RCA] and/or circumflex [CX] artery) incompletely revascularized.
Results: Overall, 3107 (22.7%) patients received IR. After propensity score matching, IR did not increase all-cause death in the overall group (HR 1.09; 95%CI 0.96-1.22; P=0.17). However, when both RCA and CX artery were incompletely revascularized, late survival was significantly lower (HR 2.15; 95%CI 1.57-2.93). IR was associated with a higher risk of death after off-pump (HR 1.26; 95%CI 1.05-1.49) regardless the extent of IR. After on-pump, IR significantly affected survival only when both RCA and CX artery only were incompletely revascularized (HR 2.32; 95%CI 1.27-4.22).
Conclusions: The present analysis shows that in patients with LITA-LAD graft the impact of IR on survival is marginal when only one coronary territory is left ungrafted. When both the RCA and CX territory remain unrevascularized the survival rate is significantly reduced. IR after off-pump CABG is associated with significantly lower survival and affects long-term outcome even when only one coronary territory is not revascularized.
(Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.)
Databáze: MEDLINE
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