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Ostial left main coronary artery stenosis as an additional risk factor in off-pump coronary artery bypass grafting
Hui-Li Gan1, Jian-Qun Zhang, Wei Xiao
1Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China. ganhuili@hotmail.com
Insights
Ostial left main coronary artery stenosis (LMS) increases early mortality and adverse events after off-pump coronary artery bypass grafting (CABG). Careful intraoperative monitoring is advised for ostial LMS patients undergoing off-pump CABG.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Medicine
Background:
- Assessing risks associated with left main coronary artery stenosis (LMS) in off-pump coronary artery bypass grafting (CABG).
- Comparing outcomes for non-left main disease, nonostial LMS, and ostial LMS patients undergoing off-pump CABG.
Purpose of the Study:
- To determine if general LMS and ostial LMS present unique risks during off-pump CABG.
- To compare the safety and efficacy of off-pump CABG in patients with varying degrees of LMS.
Main Methods:
- Retrospective analysis of 4366 patients undergoing primary isolated off-pump CABG.
- Classification into non-left main disease, nonostial LMS, and ostial LMS groups.
- Propensity score matching and Kaplan-Meier analysis for major adverse cardiac and cerebrovascular events (MACCEs).
Main Results:
- Ostial LMS group showed significantly higher 30-day mortality (6.41%) and MACCEs (20.5%) compared to other groups.
- Early MACCEs odds ratio for ostial LMS versus non-left main disease was 3.74.
- No significant difference in MACCEs-free survival at long-term follow-up.
Conclusions:
- Ostial LMS is associated with increased early mortality and MACCEs following off-pump CABG.
- Recommend enhanced intraoperative surveillance and a lower threshold for on-pump conversion in ostial LMS cases.
- Off-pump CABG can be considered for ostial LMS, but with heightened vigilance.
Background:
Our aim was to determine whether general left main coronary artery stenosis (LMS) and ostial LMS pose additional risks after off-pump coronary artery bypass grafting (CABG) relative to non-left main coronary artery stenosis.
Methods:
From January 1, 2008, to December 31, 2009, 4366 patients underwent primary isolated off-pump CABG at Beijing Anzhen Hospital. Disease was retrospectively classified as non-left main disease (n = 3523), nonostial LMS (n = 765), and ostial LMS (n = 78). Groups were propensity score matched. Kaplan-Meier freedoms from major adverse cardiac and cerebrovascular events (MACCEs) were calculated.
Results:
During the first 30 postoperative days, mortality was significantly higher in the ostial LMS group (6.41%) than in non-left main disease (0.855%, χ(2) = 7.78, P = .005) and nonostial LMS (1.28%, χ(2) = 4.71, P = .03) groups. Incidence of MACCEs was significantly higher in the ostial LMS group (20.5%) than in non-left main disease (5.98%, P = .000) and nonostial LMS (9.62%, P = .002) groups. Odds ratio for early MACCEs of ostial LMS versus non-left main disease was 3.74 (95% confidence interval, 1.72-8.17). At mean follow-up 12.8 ± 7.5 months and cumulative follow-up 498.5 patient-years, difference among groups in freedom from MACCEs did not reach statistical significance (χ(2) = 2.39, P = .303).
Conclusions:
Ostial LMS poses additional early risks of mortality and MACCEs in off-pump CABG. Off-pump CABG for ostial LMS should proceed with greater of intraoperative surveillance and lower threshold for converting to on-pump CABG.
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