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Published on: March 27, 2018
Impact of Functional vs Anatomic Complete Revascularization in Coronary Artery Bypass Grafting
Suk Ho Sohn1, Yoonjin Kang1, Ji Seong Kim1
1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Insights
Functional completeness of revascularization, not just anatomic completeness, significantly impacts long-term survival in patients undergoing coronary artery bypass grafting (CABG). This finding is crucial for improving patient outcomes after CABG surgery.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Coronary artery bypass grafting (CABG) is a critical procedure for managing advanced coronary artery disease.
- The completeness of revascularization, both anatomically and functionally, is hypothesized to influence long-term patient outcomes.
- Evaluating these aspects is essential for optimizing surgical strategies and patient prognosis.
Purpose of the Study:
- To assess the impact of functional versus anatomic complete revascularization on long-term clinical outcomes in patients undergoing CABG.
- To identify which measure of revascularization completeness is a stronger predictor of survival.
- To inform clinical decision-making regarding the goals of CABG procedures.
Main Methods:
- A cohort of 1162 patients undergoing primary isolated off-pump CABG for 3-vessel disease was analyzed.
- Data on functional completeness (myocardial single photon emission computed tomography) and anatomic completeness (graft angiography) were collected.
- Long-term survival was evaluated using univariate and multivariate analyses over a median follow-up of 82.4 months.
Main Results:
- Functional complete revascularization was achieved in 92.7% of patients, while anatomic completeness was achieved in 87.3%.
- Functional completeness was a significant predictor of long-term survival (P = .038), whereas anatomic completeness was not (P = .859).
- Multivariate analysis confirmed functional completeness (HR, 1.54; P = .019) as a significant factor, along with age, underweight status, diabetes, CKD, COPD, and LV dysfunction.
Conclusions:
- Functional completeness of revascularization, assessed pre- and post-operatively, is a more significant determinant of long-term survival after CABG than anatomic completeness alone.
- Achieving functional revascularization should be prioritized to improve patient outcomes.
- These findings highlight the importance of physiological assessment in addition to anatomical assessment for successful CABG outcomes.
Background:
This study was conducted to evaluate the impact of functional and anatomic complete revascularization on long-term clinical outcomes after coronary artery bypass grafting (CABG).
Methods:
Of 2034 patients who underwent primary isolated CABG between 2006 and 2017, 1162 patients who underwent off-pump CABG for 3-vessel disease and for whom data on functional and anatomic completeness of revascularization were available on the basis of preoperative myocardial single photon emission computed tomography and early postoperative graft angiography were enrolled. The median follow-up duration was 82.4 months (interquartile range, 50.8-122.4 months). Univariate and multivariate analyses were performed to evaluate the impact of the functional and anatomic completeness of revascularization on long-term survival.
Results:
Of 1162 patients, anatomic complete revascularization was achieved in 1014 patients (87.3%), whereas functional complete revascularization was achieved in 1077 patients (92.7%). Early mortality occurred in 7 patients. Late death occurred in 322 of 1155 early survivors. The 5- and 10-year overall survival rates were 84.3% and 66.7%, respectively. Univariate analyses demonstrated that functional completeness of revascularization was a statistically significant risk factor (P = .038), whereas anatomic completeness was not (P = .859). The multivariate analysis showed that functional completeness of revascularization (hazard ratio, 1.54; 95% CI, 1.08-2.22; P = .019) and age, underweight status, diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, and left ventricular dysfunction were significant factors associated with long-term survival.
Conclusions:
Functional rather than anatomic completeness of revascularization has a significant impact on the long-term survival in patients who undergo CABG.
