Adjunct Coronary Endarterectomy in CABG: Risk Stratification and Midterm Outcomes

Complete revascularization in diffuse coronary artery disease (CAD) is challenging when target vessels are small and circumferentially diseased. Coronary endarterectomy (CE) can enable reconstruction where a standard distal anastomosis is not feasible, but its impact remains debated. This study aimed to evaluate the impact of concomitant CE with coronary artery bypass grafting (CABG) on midterm outcomes and explore the potential risk factors for adverse events.

A single-center, retrospective cohort (2017-2022) of patients who underwent CABG with or without CE (n = 406; CE n = 97, CABG-only n = 309). The prespecified primary endpoint was major adverse cardiovascular events (all-cause mortality or myocardial infarction [MI]) assessed in-hospital/30 days and up to 72 months. CE-subgroup risk modelling used Firth penalized logistic regression. Effects were summarized as odds ratios (95% confidence intervals [CIs]); time-to-event analyses used Kaplan-Meier.

Early perioperative MI and in-hospital mortality did not differ significantly between groups. Over 72 months, overall survival was similar (log-rank p = 0.289). Within the CE cohort, midterm MI (1.0%) and stroke (2.1%) were infrequent. In multivariable CE-subgroup modelling, renal impairment, female sex, peripheral vascular disease (PVD), and age ≥65 were independently associated with complications.

Selective CE with CABG yielded comparable early and midterm outcomes to CABG-only, with low midterm complication rates. Risk was concentrated among women, patients with renal impairment or PVD, and those aged ≥65 years, supporting heightened perioperative vigilance and tailored follow-up in these subgroups.