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Published on: May 29, 2015
Risk Factors for Coronary Events After Robotic Hybrid Off-Pump Coronary Revascularization
Aleksander Dokollari1,2, Beatrice Bacchi3, Serge Sicouri1
1Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA.
Insights
Long-term complications like angina and repeat revascularization after robotic hybrid coronary revascularization (HCR) are influenced by specific patient factors. Addressing modifiable risks may improve outcomes for patients undergoing HCR.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Long-term outcomes after robotic hybrid coronary revascularization (HCR) are not well-defined.
- Understanding risk factors for post-HCR coronary events is crucial for patient management.
Purpose of the Study:
- To identify risk factors for angina, myocardial infarction (MI), and repeat revascularization after robotic HCR.
- To analyze the time-varying effects of these risk factors on patient outcomes.
Main Methods:
- Retrospective analysis of 875 patients who underwent robotic HCR.
- Exploration of baseline characteristics as potential risk factors for adverse coronary events.
Main Results:
- Angina (15.3%), repeat revascularization (15.8%), and MI (4.1%) occurred after a median follow-up of 3.32 years.
- Hazard rates for outcomes increased over time, with a peak around two years for angina.
- Risk factors included lack of radial artery graft, black race, diabetes, obesity, COPD, low ejection fraction, severe left main stenosis, and multi-vessel disease.
Conclusions:
- Modifiable periprocedural risk factors significantly impact long-term prognosis after robotic HCR.
- Targeting these factors can potentially improve patient outcomes and reduce coronary events.
Objectives:
The impact of long-term complications after robotic hybrid coronary revascularization (HCR), including persistent angina, repeat revascularization, and myocardial infarction (MI), remains limited. This study aims to determine the risk factors for coronary events after robotic HCR and their time-varying effects on outcomes.
Methods:
We identified all consecutive patients who underwent robotic HCR at our institution. Baseline characteristics were explored as possible risk factors for angina, MI, and repeat revascularization with stents at any time during the follow-up.
Results:
A total of 875 patients (mean age 71.1 ± 11.1 years) were included. After a median follow-up of 3.32 years (IQR 1.18-6.34 years), angina occurred in 134 patients (15.3%), repeat revascularization with stents in 139 patients (15.8%), and MI in 36 patients (4.1%). The hazard rates for all outcomes increased with follow-up time, with a notable early rise around two years of follow-up for angina and, to a lesser extent, repeat revascularization. The risk factors were the lack of radial artery graft use, black race, diabetes, obesity, chronic obstructive pulmonary disease, low ejection fraction <50%, severe left main coronary artery stenosis (>50%), and more than three-vessel disease.
Conclusions:
Optimization of modifiable periprocedural risk factors may positively impact long-term prognosis in patients undergoing robotic HCR.
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