Related Experiment Video
Updated: Aug 11, 2025
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Revascularization of Occluded Right Coronary Artery and Outcome After Coronary Artery Bypass Grafting
Fausto Biancari1,2,3, Magnus Dalén4, Tuomas Tauriainen1,2
1Hear and Lung Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
Insights
Revascularizing an occluded right coronary artery (RCA) during isolated coronary artery bypass grafting (CABG) significantly reduces 5-year mortality and major adverse cardiovascular and cerebrovascular events (MACCEs). Failure to revascularize increases patient risk.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Isolated coronary artery bypass grafting (CABG) is a standard treatment for multivessel coronary artery disease.
- The management of totally occluded right coronary arteries (RCAs) during isolated CABG remains a subject of debate.
- Patient outcomes following CABG can be influenced by revascularization strategies for specific coronary territories.
Purpose of the Study:
- To evaluate the impact of revascularizing totally occluded right coronary arteries (RCAs) in patients undergoing isolated coronary artery bypass grafting (CABG).
- To compare early and late clinical outcomes between patients with and without RCA revascularization.
- To assess the association between non-revascularization of the occluded RCA and adverse cardiovascular events.
Main Methods:
- Prospective European multicenter registry including patients undergoing isolated CABG.
- Propensity score matching analysis to adjust for preoperative variable imbalances.
- Kaplan-Meier method and competing risk analysis for late outcome evaluation.
Main Results:
- Analysis included 724 patients with totally occluded RCAs; 251 (34.7%) did not undergo RCA revascularization.
- Propensity score-matched analysis of 245 pairs showed similar early outcomes.
- Non-revascularized RCA group had higher 5-year all-cause mortality (17.7% vs 11.7%) and MACCE rates (24.7% vs 15.7%) compared to revascularized group.
Conclusions:
- Approximately one-third of totally occluded RCAs were not revascularized during isolated CABG in this multicenter study.
- Failure to revascularize an occluded RCA during isolated CABG is associated with increased 5-year all-cause mortality.
- Non-revascularization of the occluded RCA significantly increases the risk of major adverse cardiovascular and cerebrovascular events (MACCEs) at 5 years.
Objectives:
The aim of the present study was to evaluate the results of isolated coronary artery bypass grafting (CABG) with or without revascularization of the occluded right coronary artery (RCA).
Methods:
Patients undergoing isolated CABG were included in a prospective European multicenter registry. Outcomes were adjusted for imbalance in preoperative variables with propensity score matching analysis. Late outcomes were evaluated with Kaplan-Meier's method and competing risk analysis.
Results:
Out of 2,948 included in this registry, 724 patients had a total occlusion of the RCA and were the subjects of this analysis. Occluded RCA was not revascularized in 251 (34.7%) patients with significant variability between centers. Among 245 propensity score-matched pairs, patients with and without revascularization of occluded RCA had similar early outcomes. The nonrevascularized RCA group had increased rates of 5-year all-cause mortality (17.7 vs. 11.7%, p = 0.039) compared with patients who had their RCA revascularized. The rates of myocardial infarction and repeat revascularization were only numerically increased but contributed to a significantly higher rate of MACCE (24.7 vs. 15.7%, p = 0.020) at 5 year among patients with nonrevascularized RCA.
Conclusion:
In this multicenter study, one-third of totally occluded RCAs was not revascularized during isolated CABG for multivessel coronary artery disease. Failure to revascularize an occluded RCA in these patients increased the risk of all-cause mortality and MACCEs at 5 years.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:21Cardiac Catheterization II: Right Heart Catheterization
01:28Acute Coronary Syndrome IV: Interprofessional Care