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Adjunct Coronary Endarterectomy in CABG: Risk Stratification and Midterm Outcomes

Ahmed Hasan1,2, Mohamed Gad1, Yasser Mubarak1,3

  • 1Minia Cardiothoracic University Hospital, Minia University, Cardiothoracic Surgery Department, Egypt, Minia.

The Thoracic and Cardiovascular Surgeon
|July 27, 2026
PubMed

Insights

Coronary endarterectomy (CE) with coronary artery bypass grafting (CABG) shows similar midterm outcomes to CABG alone for diffuse coronary artery disease. Risk factors for complications in the CE group include female sex, renal impairment, peripheral vascular disease, and age over 65.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Diffuse coronary artery disease (CAD) presents challenges for complete revascularization, especially with small or diseased vessels.
  • Coronary endarterectomy (CE) offers a potential solution for complex cases where standard bypass grafting is not feasible.
  • The impact of combining CE with coronary artery bypass grafting (CABG) on patient outcomes remains a subject of debate.

Purpose of the Study:

  • To evaluate the midterm outcomes of patients undergoing CABG with concomitant CE compared to CABG alone.
  • To identify potential risk factors associated with adverse events in patients who underwent CE as part of their CABG procedure.

Main Methods:

  • A retrospective cohort study included 406 patients from 2017-2022, with 97 undergoing CE and CABG, and 309 undergoing CABG-only.
  • The primary endpoint was major adverse cardiovascular events (all-cause mortality or myocardial infarction) assessed up to 72 months post-procedure.
  • Risk modeling within the CE subgroup utilized Firth penalized logistic regression, with time-to-event analyses performed using Kaplan-Meier methods.

Main Results:

  • No significant differences in early perioperative myocardial infarction or in-hospital mortality were observed between the CE and CABG-only groups.
  • Overall survival at 72 months was similar between the two groups (log-rank p=0.289).
  • Within the CE cohort, midterm rates of myocardial infarction (1.0%) and stroke (2.1%) were low. Renal impairment, female sex, peripheral vascular disease (PVD), and age ≥65 were independently associated with complications.

Conclusions:

  • Selective use of CE with CABG provides comparable early and midterm results to CABG-only, with a low rate of midterm complications.
  • Specific patient subgroups, including women, those with renal impairment or PVD, and individuals aged 65 and older, face higher risks.
  • These findings support the need for increased perioperative vigilance and individualized follow-up strategies for high-risk patients undergoing CE with CABG.
Abstract

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