Incomplete revascularization reduces survival benefit of coronary artery bypass grafting: role of off-pump surgery.
Journal article, 2008
OBJECTIVE: We sought to analyze the influence, if any, of incomplete revascularization and on/off-pump techniques on long-term mortality after coronary artery bypass grafting. METHODS: A total of 9408 patients undergoing coronary artery bypass grafting, 8461 on pump and 947 off pump, operated on between 1995 and 2004 were included in the study. Adjusted hazard function for long-term mortality was estimated with Poisson regression analysis in a model that included variables reflecting completeness of revascularization, operative method (on/off pump), and background risk factors for death. RESULTS: Mean follow-up after surgical intervention for survivors was 5.0 +/- 2.8 years (range, 0.5-10.5 years), with a total follow-up of 45,076 patient years. Leaving 1 diseased vascular segment without a bypass graft in 2- or 3-vessel disease did not increase the hazard ratio for death in comparison with complete revascularization (hazard ratio, 1.05; 95% confidence interval, 0.87-1.27; P = .60). In contrast, leaving 2 vascular segments without a bypass graft in 3-vessel disease was associated with an increased hazard ratio for death (hazard ratio, 1.82; 95% confidence interval, 1.15-2.85; P = .01). Incomplete revascularization was more common in the off-pump group (P < .001) in our study. If adjusting for incomplete revascularization, there was no significant influence of the use of on/off-pump techniques on the hazard ratio for death (hazard ratio, 1.08; 95% confidence interval, 0.82-1.40; P = .57). CONCLUSIONS: Incomplete revascularization of patients with 3-vessel disease is an independent risk factor for increased long-term mortality after coronary artery bypass grafting. In contrast, the use of on- or off-pump techniques had no significant effect on survival after adjusting for incomplete revascularization.
Angina
Percutaneous Coronary
Risk Assessment
Adult
Male
Causality
epidemiology
epidemiology
methods
Comorbidity
Female
Transluminal
epidemiology
Middle Aged
80 and over
Aged
mortality
Unstable
Reoperation
Myocardial Infarction
Coronary Stenosis
Myocardial Revascularization
mortality
Aged
Coronary Artery Bypass
methods
adverse effects
Proportional Hazards Models
Follow-Up Studies
Humans
prevention & control
Survival Rate
surgery
Coronary Artery Bypass
Angioplasty
mortality
Off-Pump
Author
Mats Johansson-Synnergren
University of Gothenburg
Rolf Ekroth
University of Gothenburg
Anders Odén
University of Gothenburg
Helena Rexius
University of Gothenburg
Lars Wiklund
University of Gothenburg
The Journal of thoracic and cardiovascular surgery
1097-685X (ISSN)
Vol. 136 1 29-36Subject Categories
Surgery
DOI
10.1016/j.jtcvs.2007.07.059
PubMed
18603050