Incidence and Determinants of Repeat Revascularization After Off- and On-Pump Multivessel Coronary Surgery

Coronary artery bypass grafting is an established treatment for multivessel coronary artery disease. However, the occurrence of repeat revascularization over extended follow-up remains clinically relevant. This study aimed to determine the long-term incidence and predictors of repeat revascularization after off-pump and on-pump multivessel coronary artery bypass grafting.

A retrospective cohort of 10,360 patients who underwent multivessel coronary artery bypass grafting between 1996 and 2017 was analyzed. Propensity score matching (1:1, caliper 0.1) was applied to preoperative variables, yielding 4421 matched pairs. Covariate balance was confirmed using standardized mean differences. Repeat revascularization was defined as any postindex percutaneous coronary intervention or redo coronary artery bypass grafting. Survival free from reintervention was evaluated using Kaplan-Meier analysis. Cox proportional hazards models identified factors associated with repeat revascularization.

Freedom from repeat revascularization at 20 years was comparable between matched off-pump and on-pump groups (93.2% vs 90.3%; P = .866). Overall, 249 patients (2.8%) underwent repeat revascularization, predominantly percutaneous coronary intervention. Increasing age and double-vessel coronary artery disease were protective, while prior percutaneous coronary intervention more than 24 hours before surgery was associated with increased risk. Surgical technique (on-pump or off-pump) was not an independent predictor.

Long-term freedom from repeat revascularization after multivessel coronary artery bypass grafting is high and comparable between off-pump and on-pump coronary artery bypass grafting. Older age and less extensive coronary disease were protective, while prior percutaneous coronary intervention conferred increased risk. These findings may guide preoperative risk stratification and long-term management planning.