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Updated: Feb 5, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
The effect of completeness of revascularization during CABG with single versus multiple arterial grafts
Thomas A Schwann1,2, Maroun B Yammine3, Abdul-Karim M El-Hage-Sleiman3
1College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio.
Insights
Incomplete revascularization after coronary artery bypass graft surgery is linked to worse long-term survival. Supra-complete revascularization improves survival in specific patient groups, particularly those with 3-vessel coronary artery disease undergoing single-arterial bypass.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Outcomes Research
Background:
- Incomplete revascularization following coronary artery bypass graft (CABG) surgery is a known predictor of suboptimal patient outcomes.
- The long-term impact of varying degrees of revascularization (incomplete, complete, and supra-complete) requires further investigation, especially concerning different CABG strategies (single-arterial vs. multi-arterial).
Purpose of the Study:
- To evaluate the 15-year mortality associated with incomplete, complete, and supra-complete coronary revascularization.
- To determine if the effects of different revascularization completeness levels on mortality differ between single-arterial and multi-arterial CABG procedures.
Main Methods:
- Analysis of 15-year mortality data from 7157 patients who underwent CABG.
- Patients were categorized by a completeness of revascularization index (CRI) into Incomplete (CRI ≤ -1), Complete (CRI = 0), and two Supra-complete groups (CRI = +1, CRI ≥ +2).
- Risk-adjusted hazard ratios for mortality were calculated using propensity score adjustment and Cox regression, comparing single-arterial and multi-arterial CABG strategies.
Main Results:
- Incomplete revascularization (4.5% of patients) was associated with significantly increased mortality across all groups, including single-arterial and multi-arterial CABG, and patients with 3-vessel coronary disease.
- Supra-complete revascularization (CRI ≥ +1) was associated with incrementally decreased mortality, particularly in single-arterial CABG and 3-vessel disease patients.
- The survival benefit of supra-complete revascularization was not observed in multi-arterial CABG patients.
Conclusions:
- Incomplete coronary revascularization adversely affects late survival regardless of the CABG grafting strategy employed.
- Supra-complete revascularization demonstrates a survival advantage in patients with 3-vessel coronary artery disease and in those undergoing single-arterial CABG, but not in multi-arterial CABG.
Introduction:
Incomplete coronary revascularization is associated with suboptimal outcomes. We investigated the long-term effects of Incomplete, Complete, and Supra-complete revascularization and whether these effects differed in the setting of single-arterial and multi-arterial coronary artery bypass graft (CABG).
Methods:
We analyzed 15-year mortality in 7157 CABG patients (64.1 ± 10.5 years; 30% women). All patients received a left internal thoracic artery to left anterior descending coronary artery graft with additional venous grafts only (single-arterial) or with at least one additional arterial graft (multi-arterial) and were grouped based on a completeness of revascularization index (CRI = number of grafts minus the number of diseased principal coronary arteries): Incomplete (CRI ≤ -1 [N = 320;4.5%]); Complete (CRI = 0 [N = 2882;40.3%]; reference group); and two Supra-complete categories (CRI = +1[N = 3050; 42.6%]; CRI ≥ + 2 [N = 905; 12.6%]). Risk-adjusted mortality hazard ratios (AHR) were calculated using comprehensive propensity score adjustment by Cox regression.
Results:
Incomplete revascularization was rare (4.5%) but associated with increased mortality in all patients (AHR [95% confidence interval] = 1.53 [1.29-1.80]), those undergoing single-arterial CABG (AHR = 1.27 [1.04-1.54]) and multi-arterial CABG (AHR = 2.18 [1.60-2.99]), as well as in patients with 3-Vessel (AHR = 1.37 [1.16-1.62]) and, to a lesser degree, with 2-Vessel (AHR = 1.67 [0.53-5.23]) coronary disease. Supra-complete revascularization was generally associated with incrementally decreased mortality in all patients (AHR [CRI = +1] = 0.94 [0.87-1.03]); AHR [CRI ≥ +2] = 0.74 [0.64-0.85]), and was driven by a significantly decreased mortality risk in single-arterial CABG (AHR [CRI = +1] = 0.90 [0.81-0.99]; AHR [CRI ≥ +2] = 0.64 [0.53-0.78]); and 3-Vessel disease patients (AHR [CRI = +1] = 0.94 [0.86-1.04]; and AHR [CRI ≥ +2] = 0.75 [0.63-0.88]) with no impact in multi-arterial CABG (AHR [CRI = +1] = 1.07 [0.91-1.26]; AHR [CRI ≥ +2] = 0.93 [0.73-1.17]).
Conclusions:
Incomplete revascularization is associated with decreased late survival, irrespective of grafting strategy. Alternatively, supra-complete revascularization is associated with improved survival in patients with 3-Vessel CAD, and in single-arterial but not multi-arterial CABG.
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