Incomplete revascularization reduces survival benefit of coronary artery bypass grafting: role of off-pump surgery.
Artikel i vetenskaplig tidskrift, 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

Författare

Mats Johansson-Synnergren

Göteborgs universitet

Rolf Ekroth

Göteborgs universitet

Anders Odén

Göteborgs universitet

Helena Rexius

Göteborgs universitet

Lars Wiklund

Göteborgs universitet

The Journal of thoracic and cardiovascular surgery

1097-685X (ISSN)

Vol. 136 29-36

Ämneskategorier

Kirurgi

DOI

10.1016/j.jtcvs.2007.07.059

PubMed

18603050