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Author Spotlight: Enhancing Coronary Artery Revascularization
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Author Spotlight: Enhancing Coronary Artery Revascularization

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Clinical Insights to Complete and Incomplete Surgical Revascularization in Atrial Fibrillation and Multivessel

Michal Pasierski1,2, Jakub Staromłyński1,2, Janina Finke1

  • 1Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland.

Frontiers in Cardiovascular Medicine
|July 5, 2022
PubMed

Insights

Complete revascularization (CR) using Coronary Artery Bypass Grafting (CABG) in patients with atrial fibrillation (AF) is safe. CR significantly lowers long-term mortality, especially in lower-risk patients undergoing off-pump CABG.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Electrophysiology

Background:

  • Complete revascularization (CR) via Coronary Artery Bypass Grafting (CABG) is recommended but underutilized.
  • The impact of CR is not well-established in higher-risk patients, specifically those with pre-operative atrial fibrillation (AF).

Purpose of the Study:

  • To evaluate the safety and effectiveness of CR in patients with pre-operative AF undergoing isolated CABG.
  • To assess the association between CR and long-term all-cause mortality in this specific patient cohort.

Main Methods:

  • Analysis of 4770 patients with pre-operative AF and multivessel coronary artery disease from the HEIST registry (2012-2020).
  • Patients were categorized by CR versus incomplete revascularization.
  • Propensity score matching (PSM) was employed to create comparable groups; primary endpoint was all-cause mortality.

Main Results:

  • After PSM, 1,009 pairs of CR and incomplete revascularization patients were analyzed (median follow-up 4.7 years).
  • No significant difference in early (<24h) or 30-day mortality between CR and non-CR groups.
  • Long-term mortality was significantly lower by nearly 20% in the CR cohort (HR 0.83; P=0.011), particularly in low-risk patients and those undergoing off-pump CABG.

Conclusions:

  • Complete revascularization in patients with pre-operative AF is a safe strategy.
  • CR is associated with improved long-term survival in this population.
  • A notable survival benefit from CR was observed in lower-risk patients undergoing off-pump CABG.
Abstract

Keywords:
CABGatrial fibrillationcomplete revascularizationlong-termsurvival

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