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Association of incomplete revascularization with long-term survival after off-pump coronary artery bypass grafting

Authors
 Gijong Yi  ;  Young-Nam Youn  ;  Hyun-Chel Joo  ;  Soonchang Hong  ;  Kyung-Jong Yoo 
Citation
 JOURNAL OF SURGICAL RESEARCH, Vol.185(1) : 166-173, 2013 
Journal Title
 JOURNAL OF SURGICAL RESEARCH 
ISSN
 0022-4804 
Issue Date
2013
MeSH
Aged ; Coronary Artery Bypass, Off-Pump/adverse effects* ; Coronary Artery Bypass, Off-Pump/mortality* ; Coronary Artery Disease*/mortality ; Coronary Artery Disease*/physiopathology ; Coronary Artery Disease*/surgery ; Coronary Circulation/physiology* ; Female ; Follow-Up Studies ; Hospital Mortality ; Humans ; Incidence ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Myocardial Revascularization/adverse effects* ; Myocardial Revascularization/mortality* ; Postoperative Complications/mortality ; Retrospective Studies ; Risk Factors ; Stroke Volume/physiology ; Treatment Outcome
Keywords
CABG ; Coronary artery bypass grafting ; Off-pump surgery ; Outcomes
Abstract
BACKGROUND: We evaluated the effect of incomplete revascularization (IR) on the long-term outcomes after off-pump coronary artery bypass grafting. MATERIALS AND METHODS: Of 1553 patients with triple-vessel disease who had undergone consecutive off-pump coronary artery bypass grafting, 1351 (87.0%) had complete revascularization (CR) and 202 had IR (13.0%). After propensity score patient matching, we had 200 patients in each group. Cardiac survival and major adverse cardiac and cerebrovascular events (MACCE) were assessed before and after patient matching. Subgroup analysis was performed to evaluate the interaction between the left ventricular ejection fraction (LVEF) and the completeness of revascularization. The follow-up duration was 60 mo. RESULTS: In the all-patient analysis, the CR group had a lower incidence of in-hospital mortality, cardiac mortality, and MACCE (P = 0.033, P < 0.001, and P = 0.003, respectively). The 5-year cardiac survival was 96.5% ± 0.6% in the CR group and 88.9% ± 2.5% in the IR group (P < 0.001), with a freedom from MACCE rate of 85.4% ± 1.2% and 78.8% ± 3.4%, respectively (P = 0.015). After patient matching, the CR group showed superior 5-year cardiac survival compared with the IR group (96.2% ± 1.4% versus 88.8% ± 2.5%, P = 0.022), with a similar freedom from MACCE rate. IR was identified as an independent predictor of cardiac death (hazard ratio 2.76, 95% confidence interval 1.62-4.70; P < 0.001). IR predicted cardiac death more distinctly in patients with a low LVEF (hazard ratio 5.29, 95% confidence interval 1.71-16.39; P = 0.004) than in those with a preserved LVEF (hazard ratio 2.04, 95% confidence interval 1.02-4.08; P = 0.045). CONCLUSIONS: CR in off-pump coronary artery bypass grafting was related to superior cardiac survival after 5 years of follow-up compared with IR. The benefit of CR was more distinct in those with a low LVEF. CR should be achieved whenever possible, especially in patients with a low LVEF.
Full Text
http://www.sciencedirect.com/science/article/pii/S0022480413004927
DOI
10.1016/j.jss.2013.05.042
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Youn, Young Nam(윤영남)
Yi, Gi Jong(이기종)
Joo, Hyun Chel(주현철) ORCID logo https://orcid.org/0000-0002-6842-2942
Hong, Soon Chang(홍순창)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/89011
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