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Does arterial revascularization decrease the risk of infarction after coronary artery bypass grafting?
P T Sergeant1, E H Blackstone, B P Meyns
1Cardiac Surgery Department, Gasthuisberg University Hospital, Leuven, Belgium.
Insights
Extensive arterial grafting in coronary artery bypass grafting significantly reduces myocardial infarction and improves survival. However, using more than one arterial graft offers no additional benefit for patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Grafting Techniques
Background:
- Assessing the impact of arterial grafting on infarct prevalence and consequences post-coronary artery bypass grafting (CABG).
- Investigating the long-term efficacy of arterial conduits in reducing myocardial infarction after CABG.
Purpose of the Study:
- To determine if extensive arterial grafting reduces infarct occurrence and its sequelae after CABG.
- To evaluate the contribution of arterial grafting to freedom from infarction.
Main Methods:
- Analysis of 9,600 patients undergoing CABG between 1971 and 1992 with 99.9% follow-up.
- Multivariable hazard function analysis to assess arterial grafting's effect on infarct risk, adjusting for covariates.
Main Results:
- Arterial grafting significantly reduced periprocedural, intermediate-term, and late infarction, especially to the left anterior descending artery (p=0.0006).
- Ten-year survival improved from 48% to 59% with arterial grafting (p=0.002).
- No additional benefit was observed from using more than one arterial graft (p > 0.1).
Conclusions:
- Arterial conduits, particularly to the left anterior descending coronary artery, are recommended for CABG to minimize early and late myocardial infarction.
- Utilizing more than a single arterial graft in CABG does not appear to provide further advantages.
Background:
This study sought to determine whether extensive arterial grafting reduces the prevalence and consequences of infarct after coronary artery bypass grafting.
Methods:
Post-primary coronary artery bypass grafting infarcts and time-related events thereafter were identified by 99.9% complete follow-up of 9,600 patients (1971 to 1992). The contribution of arterial grafting to freedom from infarct was assessed by multivariable hazard function analysis to adjust for other risk factors.
Results:
Unadjusted 1-month and 10-year freedom from infarction was 97% and 86%. By multivariable analysis, arterial grafting lowered the prevalence of periprocedural (p = 0.005), intermediate term (p = 0.007 and 0.006), and late infarction (arterial grafting to the left anterior descending coronary artery, p = 0.0006). Unadjusted survival after first infarct after coronary artery bypass grafting was 74% and 52% at 1 and 10 years; arterial grafting improved 10-year survival from 48% to 59% (p = 0.002). An additional benefit or cost of extending arterial grafting (n = 1,727) beyond a single one could not be identified (p > 0.1).
Conclusions:
Arterial conduits, particularly to the left anterior descending coronary artery, should be used for coronary artery bypass grafting to reduce early and late myocardial infarction and its consequences. However, use of more than a single arterial graft appears to confer no additional benefit.