Endarterectomy may be an effective additional treatment for three diffuse coronary artery disease complicated with
Haiming Li1, Chengxiong Gu1, Bo Li1
1Department of Cardiac Surgery, Capital Medical University Beijing Anzhen Hospital, Chaoyang-qu, Beijing, China.
Insights
Coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) offers more complete revascularization for diabetes patients with diffuse three-vessel disease. This approach reduces angina recurrence but increases perioperative myocardial infarction risk compared to CABG alone.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Diabetology
Background:
- Diabetes mellitus significantly increases the risk and complexity of coronary artery disease.
- Diffuse three-vessel coronary artery disease presents a surgical challenge, often requiring advanced revascularization techniques.
Purpose of the Study:
- To evaluate the clinical efficacy of combining coronary endarterectomy (CE) with coronary artery bypass grafting (CABG) versus isolated CABG.
- To compare perioperative outcomes, angina recurrence, and graft patency in diabetic patients with diffuse three-vessel coronary artery disease.
Main Methods:
- Retrospective analysis of 460 diabetic patients with diffuse three-vessel coronary artery disease from September 2015 to December 2021.
- Patients were divided into simple CABG (n=254) and CABG combined with CE (n=206) groups.
- Comparison of perioperative outcomes, 1-year angina recurrence, and coronary CT angiography graft patency.
Main Results:
- No significant difference in 30-day mortality between groups (2.3% vs 2.4%).
- The CABG combined with CE group showed significantly higher graft patency (2.88 vs 2.15 vessels/case) and lower angina recurrence (6.47% vs 14.49%).
- The simple CABG group had shorter operation times, fewer grafts, and lower perioperative myocardial infarction rates.
Conclusions:
- Combined CE and CABG achieves more complete revascularization in diabetic patients with diffuse three-vessel coronary artery disease.
- This combined approach reduces angina recurrence and the need for revascularization compared to isolated CABG.
- However, the combined approach is associated with a higher incidence of perioperative myocardial infarction.
Objective:
In order to evaluate the clinical efficacy of coronary endarterectomy (CE) and coronary artery bypass grafting (CABG) in patients with diabetes complicated with three diffuse coronary artery stenosis.
Methods:
A retrospective analysis was conducted on 460 patients with diabetes mellitus and diffuse three-vessel coronary artery disease who underwent CABG in our department from September 2015 to December 2021. The patients were divided into two groups according to whether they underwent CE: the simple CABG group (group A, n = 254) and the CABG combined CE group (group B, n = 206). The perioperative outcomes, recurrent angina pectoris during 1-year follow-up, and the patency rate of the grafted vessel in coronary CT angiography were compared between the two groups.
Results:
There was no significant difference in the 30 days mortality rate between the two groups (2.3% vs 2.4%, p < 0.05). Group A had a shorter operation time [(3.55 ± 0.59) h versus (4.35 ± 0.65) h], less bypass grafts [(2.72 ± 0.83) versus (3.65 ± 0.72) vessels/case], a lower incidence of perioperative myocardial infarction (7.1% vs 12.6%), and a lower number of patent graft vessels at 1-year follow-up [(2.15 ± 0.42) versus (2.88 ± 0.68) vessels/case] compared with group B (all p < 0.05). Group A had a higher incidence of recurrent angina during follow-up (14.49% vs 6.47%) (p < 0.05). Although there was no significant difference in the incidence of MACCE events between the two groups, the probability of revascularization was higher in group A.
Conclusion:
Compared with single CABG, combined CE in patients with diabetes mellitus and diffuse three-vessel coronary artery disease can achieve more complete revascularization, reduce the recurrence of angina pectoris and the needing of postoperative revascularization, but the incidence of perioperative myocardial infarction is higher.
