The impact of incomplete revascularization and angiographic patency on midterm results after off-pump coronary artery bypass grafting

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• 作者：Jota Nakano ; MD^a ; ^b ; ^{jotanakano@gmail.com" class="auth_mail} ; Hitoshi Okabayashi ; MD ; PhD^a ; ^c ; Hisashi Noma ; PhD^d ; Tosiya Sato ; PhD^d ; Ryuzo Sakata ; MD ; PhD^b
• 关键词：BITA ; bilateral internal thoracic artery ; BSA ; body surface area ; CCAB ; conventional coronary artery bypass ; COPD ; chronic obstructive pulmonary disease ; CI ; confidence interval ; CR ; complete revascularization ; CRF ; chronic renal failure ; CT ; computed tomography ; EuroSCORE ; European System for Cardiac Operative Risk Evaluation ; HR ; hazard ratio ; IR ; incomplete revascularization ; LAD ; left anterior descending ; LCx ; left anterior circumflex ; MACCE ; major adverse cardiac and cerebrovascular event
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：April, 2014
• 年：2014
• 卷：147
• 期：4
• 页码：1225-1232
• 全文大小：822 K

文摘

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Objectives

Higher rates of incomplete revascularization (IR) and reduced patency are possible drawbacks of off-pump coronary artery bypass grafting (OPCAB); both may adversely affect outcome after surgery. This study was conducted to shed light on the relationships among IR, angiographic patency, and midterm results after OPCAB surgery.

Methods

A total of 1604 consecutive patients underwent OPCAB during a 6-year period; 1581 patients (95%) underwent systematic postoperative angiography. Complete follow-up was achieved in 99.5% (median, 3.2 years; up to 6.5 years). A total of 216 patients had IR (13%), and 225 had at least 1 graft failure (FitzGibbon B聽or O).

Results

All the event-free survival rates for all-cause mortality (P聽<聽.001), cardiac death (P聽=聽.020), and major adverse cardiac and cerebrovascular events (P聽<聽.001) were lower in the IR group. By using the Cox proportional hazards model, IR was an independent risk factor for all-cause mortality (hazard ratio [HR], 1.80; 95% confidence interval [CI], 1.15-2.81). Of those who underwent postoperative angiography, the patients with graft failure experienced reintervention more frequently than those with all grafts patent (HR, 5.49; 95% CI, 3.43-8.77). Even with excluding patients who had undergone reintervention immediately after angiography, graft failure was still an independent risk factor for reintervention afterwards (HR, 2.41; 95% CI, 1.30-4.47).

Conclusions

Incomplete revascularization was relevant to higher midterm mortality after OPCAB, whereas the risk of reintervention was higher for patients with occluded grafts. Complete revascularization, coupled with achievement of a higher patency rate, could be expected to improve follow-up outcomes after OPCAB surgery.