Complete Coronary Revascularization and Outcomes in Patients Who Underwent Coronary Artery Bypass Grafting: Insights...

Area of Science:

• Cardiology
• Cardiac Surgery
• Interventional Cardiology

Background:

• Growing evidence supports complete revascularization (CR) in coronary artery disease.
• A universally accepted definition of CR in patients undergoing coronary bypass grafting surgery (CABG) is lacking.
• This study investigates outcomes based on a specific CR definition: surgical revascularization of any territory with ≥50% stenosis.

Purpose of the Study:

• To evaluate the clinical outcomes of complete revascularization (CR) versus incomplete revascularization (IR) in patients undergoing CABG.
• To assess the impact of CR on major adverse cardiac events (MACE), including death, myocardial infarction, and repeat revascularization.
• To analyze CR outcomes within the context of the Randomized Trial of Endoscopic or Open Saphenous Vein Graft Harvesting (REGROUP) cohort.

Main Methods:

• A preplanned subanalysis of the REGROUP clinical trial cohort was performed.
• Patients undergoing CABG were categorized into CR (n=810) and IR (n=337) groups based on the defined criteria.
• The primary outcome was a composite of MACE over a median follow-up of 4.7 years.

Main Results:

• CR was associated with similar rates of MACE (21.6% vs. 25.5%, HR 0.87) compared to IR.
• No significant differences were observed in all-cause death (12.0% vs. 14.2%) or nonfatal myocardial infarction (6.0% vs. 8.9%) between groups.
• CR significantly reduced the risk of repeat revascularization (7.7% vs. 11.6%, HR 0.64, p=0.027).

Conclusions:

• In a high-comorbidity CABG population from the REGROUP trial, CR demonstrated similar MACE rates but a lower incidence of repeat revascularization.
• The findings suggest a potential benefit of CR in reducing the need for subsequent interventions.
• Longer-term follow-up data are warranted to fully elucidate the enduring effects of CR in this patient group.