Impact Of Incomplete Revascularization On Long-Term Survival Based On Revascularization Strategy

Sleiman Sebastian Aboul Hassan; Ahmed K Awad; Tomasz Stankowski; Bartlomiej Perek; Jakub Marczak; Michal Rodzki; Marek Jemielity; Lukasz Moskal; Michel Pompeu Sá; Gianluca Torregrossa; Mario Gaudino; Romuald Cichon

doi:10.1016/j.athoracsur.2024.04.032

Impact Of Incomplete Revascularization On Long-Term Survival Based On Revascularization Strategy

Ann Thorac Surg. 2024 May 20:S0003-4975(24)00374-6. doi: 10.1016/j.athoracsur.2024.04.032. Online ahead of print.

Authors

Affiliations

¹ Department of Cardiac Surgery, MEDINET Heart Center Ltd, Nowa Sol, Poland; Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, Zielona Gora, Poland. Electronic address: s.aboulhassan@inm.uz.zgora.pl.
² Department of Cardiac Surgery, MEDINET Heart Center Ltd, Nowa Sol, Poland; Faculty of Medicine, Ain shams University, Cairo, Egypt.
³ Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany.
⁴ Department of Cardiac Surgery and Transplantology, Chair of Cardio Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland.
⁵ Department of Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest NHS Foundation Trust, Liverpool, UK.
⁶ Department of Cardiac Surgery, MEDINET Heart Center Ltd, Nowa Sol, Poland; Department of Cardiac Surgery, MEDINET Heart Center Ltd, Wroclaw, Poland.
⁷ Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, USA; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, USA.
⁸ Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA; Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA.
⁹ Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, USA.
¹⁰ Department of Cardiac Surgery, MEDINET Heart Center Ltd, Nowa Sol, Poland; Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, Zielona Gora, Poland; Department of Cardiac Surgery, MEDINET Heart Center Ltd, Wroclaw, Poland.

PMID: 38777249
DOI: 10.1016/j.athoracsur.2024.04.032

Abstract

Background: This study aimed to investigate the impact of complete(CR) and incomplete(IR) revascularization on long term survival in patients undergoing isolated coronary artery bypass grafting(CABG) using either multiple arterial graft(MAG) or single artery with saphenous vein grafts(SAG) .

Methods: Between January 2006 and December 2020, 12625 patients had CABG and were divided into four groups: MAG CR(n=1066), MAG IR(n=286), SAG CR(n=8360) and SAG IR(n=2913). Inverse probability of treatment weighting(IPTW) based on the generalized propensity score was used to minimize imbalance between the groups.

Results: In the weighted cohort, median follow up time was 8.35 years(interquartile range:5.01-11.6). MAG CR was associated with similar long term survival when compared to MAG IR(HR:0.79;95%CI:0.60 1.03;P=0.084). SAG CR was associated with improved long term survival when compared to SAG IR(HR:0.67;95%CI:0.52 0.84;P=0.01). MAG CR was associated with better long term survival when compared to SAG CR(HR:0.45;95%CI:0.35 0.57;P<0.001)(Figure 2). Moreover, MAG IR was protective when compared with SAG IR(HR:0.62;95%CI:0.45 0.85;P=0.033). Additional analysis was performed comparing perfect CR vs imperfect CR vs IR in MAG and SAG, separately. In the weighted sample of MAG, there were no differences in the long term survival between perfect CR, imperfect CR and IR. However, in the weighted sample of SAG cohort, SAG perfect CR was associated with improved survival compared to SAG imperfect CR(HR:0.81;95%CI:0.0.72 0.92;P=0.001). Whereas, both SAG perfect CR and SAG imperfect CR were associated with improved survival compared to SAG IR(HR:0.51;95%CI:0.0.35 0.87;P=0.006) and (HR:0.72;95%CI:0.64 0.82;P<0.001),respectively.

Conclusions: MAG CR is associated with better survival compared to SAG CR. If IR is inevitable, patients with MAG IR had better long term survival when compared to patients receiving SAG IR. Moreover, similar long term survival is observed whether perfect CR, imperfect CR or IR is achieved in the MAG population but not in SAG.

Keywords: complete revascularization; coronary artery bypass grafting; incomplete revascularization; long term survival; multiple arterial grafts; single arterial grafts.