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Published on: March 27, 2018
Rate of Incomplete Revascularization Following Coronary Artery Bypass Grafting at a Single Institution Between 2007
Chase R Soukup1, Christian W Schmidt2, Carmen Chan-Tram2
1The Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; The University of Minnesota School of Medicine, Minneapolis, Minnesota.
Insights
The rate of incomplete revascularization after coronary artery bypass grafting (CABG) increased significantly from 2007 to 2017. This rise in incomplete revascularization was linked to higher cardiovascular mortality in CABG patients.
Area of Science:
- Cardiology
- Surgical Outcomes
Background:
- Incomplete revascularization post-coronary artery bypass grafting (CABG) correlates with adverse outcomes.
- Trends in incomplete revascularization rates over time are not well-documented.
Purpose of the Study:
- To investigate the change in incomplete revascularization rates following CABG between 2007 and 2017.
- To assess the association between these changing rates and cardiovascular mortality.
Main Methods:
- Retrospective comparison of patients undergoing elective isolated CABG in 2007 (n=291) and 2017 (n=290).
- Utilized a Revascularization Index Score to quantify the completeness of revascularization based on coronary anatomy and stenosis.
- Compared 2-year cardiovascular mortality between the two cohorts.
Main Results:
- The rate of incomplete revascularization rose from 17.9% in 2007 to 28.3% in 2017 (p=0.003).
- The Revascularization Index Score decreased from 0.73 to 0.67 (p=0.005), indicating less complete revascularization over time.
- Two-year cardiovascular mortality was significantly higher in the 2017 cohort.
Conclusions:
- Incomplete revascularization after CABG has significantly increased between 2007 and 2017.
- This increase in incomplete revascularization is associated with elevated cardiovascular mortality.
- Patient factors like older age, increased smoking, and prior percutaneous coronary intervention may contribute to these trends.
Abstract:
Incomplete revascularization following coronary artery bypass grafting (CABG) is associated with increased repeat revascularization, myocardial infarction and death. Whether the rate of incomplete revascularization is increasing over time has not been previously described. All patients with multivessel coronary artery disease who underwent isolated and elective CABG at our Institution in 2007 (n = 291) were compared to patients who underwent CABG in 2017 (n = 290). A Revascularization Index Score was created to compare rates of incomplete revascularization between the 2 years based on the coronary anatomy and degree of stenosis. Comparison of the 2 years disclose that the rate of incomplete revascularization increased from 17.9% in 2007 to 28.3% in 2017 (p = 0.003) and was accompanied by a decline in the Revascularization Index Score from 0.73 to 0.67 (p = 0.005). Left ventricular function improved in both groups following CABG. Two-year cardiovascular mortality was significantly higher in the 2017 cohort compared to the 2007 cohort. These differences may be attributable to patient factors including more severe coronary artery disease associated with older age, greater incidence of smoking and previous percutaneous coronary intervention. In conclusion, the rate of incomplete revascularization following CABG significantly increased in 2017 compared to 2007 and was associated with higher cardiovascular mortality.
