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Published on: May 14, 2013
Impact of Incomplete Revascularization on Long-term Survival Based on Revascularization Strategy
Sleiman Sebastian Aboul-Hassan1, Ahmed K Awad2, Tomasz Stankowski3
1Department of Cardiac Surgery, MEDINET Heart Center Ltd, Nowa Sól, Poland; Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, Zielona Góra, Poland.
Insights
Complete revascularization (CR) using multiple arterial grafts (MAGs) shows better survival than single artery with vein grafts (SAGs). Incomplete revascularization (IR) with MAGs also yields better outcomes than with SAGs, highlighting graft choice importance.
Area of Science:
- Cardiovascular Surgery
- Surgical Outcomes Research
Background:
- Coronary artery bypass grafting (CABG) is a common procedure.
- Graft choice (multiple arterial grafts vs. single artery with vein grafts) and completeness of revascularization impact patient outcomes.
Purpose of the Study:
- To compare long-term survival after CABG based on graft type (MAGs vs. SAGs) and revascularization status (complete vs. incomplete).
Main Methods:
- Retrospective analysis of 12,625 patients undergoing isolated CABG from 2006-2020.
- Patients categorized into four groups: MAG CR, MAG IR, SAG CR, and SAG IR.
- Inverse probability of treatment weighting (IPTW) used to balance covariates.
Main Results:
- Multiple arterial grafts (MAGs) with complete revascularization (CR) showed better survival than single artery with vein grafts (SAGs) with CR.
- MAGs with incomplete revascularization (IR) also had better survival than SAGs with IR.
- In the MAG group, survival was similar across perfect CR, imperfect CR, and IR.
- In the SAG group, perfect CR and imperfect CR were associated with improved survival compared to IR.
Conclusions:
- Multiple arterial grafts (MAGs) offer superior long-term survival compared to single artery with vein grafts (SAGs) in CABG patients.
- When incomplete revascularization (IR) is unavoidable, MAGs provide better outcomes than SAGs.
- The degree of revascularization (perfect CR, imperfect CR, or IR) significantly impacts survival in SAG patients but not in MAG patients.
Background:
This study investigated the impact of complete revascularization (CR) and incomplete revascularization (IR) on long-term survival in patients undergoing isolated coronary artery bypass grafting (CABG) using multiple arterial graft (MAGs) or a single artery with saphenous vein grafts (SAGs).
Methods:
Between January 2006 and December 2020, 12,625 patients underwent CABG and were divided into 4 groups: MAG CR (n = 1066), MAG IR (n = 286), SAG CR (n = 8360), and SAG IR (n = 2913). Inverse probability of treatment weighting based on the generalized propensity score was used to minimize imbalance between the groups.
Results:
In the weighted cohort, median follow-up time was 8.35 years (interquartile range, 5.01-11.6 years). MAG CR was associated with similar long-term survival compared with MAG IR (hazard ratio [HR], 0.79; 95% CI, 0.60-1.03; P = .084). SAG CR was associated with improved long-term survival compared with SAG IR (HR, 0.67; 95% CI, 0.52-0.84; P = .01). MAG CR was associated with better long-term survival compared with SAG CR (HR, 0.45; 95% CI, 0.35-0.57; P < .001). Moreover, MAG IR was protective compared with SAG IR (HR, 0.62; 95% CI, 0.45-0.85; P = .033). Additional analysis was performed comparing perfect CR vs imperfect CR vs IR in MAG and SAG patients, separately. In the weighted sample of MAG, there were no differences in the long-term survival between perfect CR, imperfect CR, and IR. However, in the weighted sample of the SAG cohort, SAG perfect CR was associated with improved survival compared with SAG imperfect CR (HR, 0.81; 95% CI, 0.0.72-0.92; P = .001). Whereas, SAG perfect and imperfect CR were both associated with improved survival compared with SAG IR (HR, 0.51; 95% CI, 0.0.35-0.87; P = .006 and HR, 0.72; 95% CI, 0.64-0.82; P < .001), respectively.
Conclusions:
MAG CR is associated with better survival compared with SAG CR. If IR is inevitable, patients with MAG IR had better long-term survival compared with patients receiving SAG IR. Moreover, similar long-term survival is observed whether perfect CR, imperfect CR, or IR is achieved in the MAG population but not in SAG patients.
