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Updated: Oct 28, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Complete revascularization during coronary artery bypass grafting is associated with reduced major adverse events
Valentino Bianco1, Arman Kilic2, Edgar Aranda-Michel1
1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa.
Insights
Complete revascularization in coronary artery bypass grafting significantly improves survival and reduces major adverse cardiac events. Incomplete revascularization of non-main branch vessels does not impact mortality or adverse events.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Literature on complete revascularization is limited by inconsistent definitions and patient cohorts.
- Accurate risk-adjusted outcomes are crucial for evaluating complete revascularization strategies.
Purpose of the Study:
- To provide risk-adjusted outcomes for complete revascularization of significant non-main branch and main branch vessel stenoses.
- To compare outcomes between complete and incomplete revascularization in patients undergoing coronary artery bypass grafting.
Main Methods:
- Analysis of 3356 patients undergoing first-time isolated coronary artery bypass grafting.
- Utilized Kaplan-Meier survival estimates, cumulative incidence function, and Cox regression.
- Risk adjustment performed using inverse probability treatment weighting to balance baseline characteristics.
Main Results:
- Complete revascularization (73.5%) was associated with significantly better 1-year and 5-year survival (P=0.05).
- Freedom from major adverse cardiac and cerebrovascular events was significantly higher with complete revascularization at 1 and 5 years (P<0.001).
- Complete revascularization independently reduced major adverse cardiac and cerebrovascular events (HR, 0.82; P=0.01). Incomplete revascularization of non-main branch vessels showed no significant association with mortality or adverse events.
Conclusions:
- Complete surgical revascularization of all stenotic vessels in multivessel coronary artery disease improves outcomes.
- Incomplete revascularization of non-main branch vessels does not adversely affect survival or major adverse cardiac and cerebrovascular events.
Objective:
Complete revascularization literature is limited by variance in patient cohorts and inconsistent definitions. The objective of the current study was to provide risk-adjusted outcomes for complete revascularization of significant nonmain-branch and main-branch vessel stenoses.
Methods:
All patients that underwent first-time isolated coronary artery bypass grafting procedures were included. Kaplan-Meier survival estimates, cumulative incidence function, and Cox regression were used to analyze outcomes.
Results:
The total population consisted of 3356 patients that underwent first-time isolated coronary artery bypass grafting. Eight hundred eighty-nine (26.5%) patients had incomplete and 2467 (73.5%) had complete revascularization. For main-branch vessels, 677 (20.2%) patients had incomplete revascularization and 2679 (79.8%) were completely revascularized. Following risk adjustment with inverse probability treatment weighting, all baseline characteristics were balanced (standardized mean difference, ≤ 0.10). On Kaplan-Meier estimates, survival at 1 year (94.6% vs 92.5%) and 5 years (86.5% vs 82.1%) (P = .05) was significantly better for patients who received complete revascularization. Freedom from major adverse cardiac and cerebrovascular events was significantly higher for the complete revascularization cohort at both 1 year (89.2% vs 84.2%) and 5 years (72.5% vs 66.7%) (P < .001). Complete revascularization (hazard ratio, 0.82; 95% confidence interval, 0.70-0.95; P = .01) was independently associated with a significant reduction in major adverse cardiac and cerebrovascular events. Incomplete revascularization of nonmain-branch vessels was not associated with mortality (hazard ratio, 1.14; 95% confidence interval, 0.74-1.8; P = .55) or major adverse cardiac and cerebrovascular events (hazard ratio, 0.90; 95% confidence interval, 0.66-1.24; P = .52).
Conclusions:
Complete surgical revascularization of all angiographically stenotic vessels in patients with multivessel coronary artery disease is associated with fewer major adverse events. Incomplete revascularization of nonmain-branch vessels is not associated with survival or major adverse cardiac and cerebrovascular events.
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