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Published on: March 27, 2018
Impact of Complete Revascularization on Long-Term Outcomes After Coronary Artery Bypass Grafting in Patients With
Yangsin Lee1,2, Takayuki Ohno2, Yukari Uemura3
1Department of Cardiac Surgery, The University of Tokyo Hospital.
Insights
Complete revascularization (CR) after coronary artery bypass grafting (CABG) in patients with left ventricular (LV) dysfunction did not impact long-term mortality. However, CR may reduce repeat revascularization and major adverse cardiac events.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Medicine
Background:
- Long-term outcomes of complete revascularization (CR) in patients with left ventricular (LV) dysfunction undergoing coronary artery bypass grafting (CABG) are not well-defined.
- LV dysfunction is a critical factor influencing outcomes after CABG.
Purpose of the Study:
- To evaluate the long-term impact of CR versus incomplete revascularization (IR) on mortality and major adverse cardiac and cerebrovascular events (MACCE) in patients with LV dysfunction undergoing CABG.
Main Methods:
- A consecutive series of 111 patients with LV ejection fraction ≤35% undergoing isolated first-time CABG were analyzed.
- Patients were divided into CR (n=63) and IR (n=48) groups.
- Outcomes including all-cause mortality, cardiac death, and MACCE were assessed at a median follow-up of 10.1 years, with propensity score adjustment.
Main Results:
- Incomplete revascularization (IR) was associated with significantly higher rates of all-cause death, cardiac death, and MACCE at follow-up.
- After propensity score adjustment, no significant difference in all-cause mortality (HR 1.45; P=0.271) or cardiac death (HR 1.45; P=0.337) was observed between CR and IR groups.
- IR significantly increased the risk of MACCE (HR 1.92; P=0.027), primarily due to a higher risk of repeat revascularization (HR 3.92; P=0.013).
Conclusions:
- Incomplete revascularization (IR) was not significantly associated with increased long-term mortality in patients with LV dysfunction undergoing CABG.
- Complete revascularization (CR) may reduce the risk of repeat revascularization and subsequent MACCE in this patient population.
Background:
The long-term outcomes of complete revascularization (CR) in patients with left ventricular (LV) dysfunction undergoing coronary artery bypass grafting (CABG) remain unclear.
Methods And Results:
We evaluated a consecutive series of 111 patients with LV ejection fraction ≤35% who underwent isolated first-time CABG: 63 underwent CR and 48 underwent incomplete revascularization (IR). At a median follow-up of 10.1 years, the rates of death from any cause, cardiac death, and major adverse cardiac and cerebrovascular events (MACCE) were significantly greater in the IR group. After adjusting for propensity score, no significant difference was found between the CR and IR groups regarding death from any cause (hazard ratio [HR], 1.45; 95% CI: 0.75-2.81; P=0.271) and cardiac death (HR, 1.45; 95% CI: 0.68-3.10; P=0.337). In contrast, IR increased the risk of MACCE (HR, 1.92; 95% CI: 1.08-3.41; P=0.027), which was principally attributed to an increased risk of repeat revascularization (HR, 3.92; 95% CI: 1.34-11.44; P=0.013).
Conclusions:
Although IR was not significantly associated with an increased risk of long-term mortality in patients with LV dysfunction who underwent CABG, CR might reduce the risks of repeat revascularization and subsequent MACCE.
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