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Published on: March 27, 2018
Incomplete revascularization after coronary artery bypass graft operations is independently associated with worse
Valentin Mocanu1, Karen J Buth1, Ryan Kelly1
1Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
Incomplete revascularization (IR) after bypass surgery impacts long-term survival and cardiac readmissions. Avoiding IR is crucial for better patient outcomes in coronary artery bypass graft operations.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Complete revascularization (CR) is theorized to improve patient outcomes.
- The frequency of incomplete revascularization (IR) and its impact after coronary artery bypass graft (CABG) surgery require further investigation.
Purpose of the Study:
- To determine the frequency of IR after isolated CABG operations.
- To assess the association between IR and long-term mortality and cardiac readmissions.
Main Methods:
- Retrospective analysis of 8,570 patients undergoing isolated CABG from March 1995 to September 2007.
- Defined IR as failure to graft each significantly diseased territory.
- Used Cox proportional hazards models to analyze outcomes, adjusting for covariates.
Main Results:
- IR occurred in 19% of patients, most frequently affecting the right coronary and circumflex territories.
- IR was an independent predictor of increased long-term mortality (HR 1.2; 95% CI 1.1-1.3).
- IR also predicted increased hospital readmissions for cardiac reasons (HR 1.2; 95% CI 1.0-1.3).
Conclusions:
- Despite surgical advances, IR remains prevalent in up to 19% of CABG patients.
- IR significantly increases the risk of long-term death and cardiac readmissions.
- Minimizing IR should be a priority during surgical planning to improve patient prognosis.
Background:
Complete revascularization (CR) has been suggested to provide benefits to both early and long-term outcomes, but the magnitude of the benefit and frequency of incomplete revascularization (IR) after coronary artery bypass graft operations is rarely explored and is the subject of the present study.
Methods:
All patients who underwent isolated bypass operations (March 1995 to September 2007) at the Queen Elizabeth II Health Sciences Center (Halifax, NS, Canada) were identified. Revascularization was considered complete if each significantly diseased territory received at least 1 graft. Clinical characteristics of the CR and IR groups were examined to determine barriers of CR. A nonparsimonious Cox proportion model and survival curves were constructed to examine the association of CR and death after adjusting for clinically relevant covariates.
Results:
A total of 8,570 patients underwent isolated nonredo bypass operations. IR, based on our strict definition, occurred in 19% of the patients. The territories most commonly affected were the right coronary and circumflex coronary territories. After adjustment for relevant clinical differences, IR was a significant independent predictor of long-term mortality (hazard ratio, 1.2; 95% confidence interval, 1.1 to 1.3). IR was also a significant independent predictor of hospital readmission for cardiac reasons after discharge (hazard ratio, 1.2; 95% confidence interval, 1.0 to 1.3).
Conclusions:
Despite advances in surgical revascularization, IR can occur in up to 19% of patients. IR significantly affects long-term death and readmission to hospital for cardiac reasons, and avoiding IR should therefore be a priority for surgeons during preoperative planning.
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