Total arterial revascularization is associated with long-term survival benefit in coronary artery bypass grafting: systematic review with meta-analysis

Autor: J Ren, A Royse, D Tian, C Royse, S Boggett, R Bellomo, M Gaudino, S Fremes
Rok vydání: 2022
Předmět:
Zdroj: European Heart Journal. 43
ISSN: 1522-9645
0195-668X
Popis: Importance Total arterial revascularization (TAR), the complete avoidance of saphenous vein grafting (SVG) in coronary artery bypass grafting (CABG), is advocated based on the superior conduit durability and resistance against atherosclerosis. However, the low adoption rate of TAR indicates a high level of controversy. Objective To compare long-term survival between TAR and conventional CABG involving SVG. Data sources A comprehensive literature search was conducted through digital databases including MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from the inception to May 2021. Study selection The inclusion criteria were randomized clinical trials, or propensity-score balanced or multivariable-adjusted observational studies with a sample size of at least 100 patients in each arm, isolated CABG, comparing TAR (SVG=0) vs. non-TAR (SVG≥1), and inclusion of all-cause mortality. Data extraction and synthesis Two reviewers performed independent extraction following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Pooled hazard ratios (HR) and 95% confidence intervals (CI) were estimated with random-effect and fixed-effect models using generic inverse variance weighting. Individual patient time-to-event data were reconstructed to create an overall Kaplan-Meier survival function for matched studies. Sensitivity analyses were performed according to the risk of bias, matching status, and source of HR. Main outcomes and measures The primary endpoint was all-cause mortality. Results A total of 23 studies (100,314 patients), all with a retrospective observational design, were identified. The weighted mean follow-up time was 8.8 years post-operatively. Total arterial revascularization was associated with greater freedom from all-cause mortality than non-TAR (HR, 0.77, 95% CI, 0.71 to 0.84, p Conclusions and relevance This meta-analysis found superior late survival associated with total arterial revascularization. Further randomized clinical trials are needed. Funding Acknowledgement Type of funding sources: None.
Databáze: OpenAIRE
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