Complete revascularization of triple-vessel disease in coronary artery bypass grafting reduces postoperative major adverse event rates： A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QIN Mingzhen , LIU Xiankun , GAO Shaobo , WANG Lianqun ,  WANG Qiang , GUO Zhigang ,  BAI Yunpeng

Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, 300222, P. R. China;

Corresponding author：

WANG Qiang, Email: oliverwhite@126.com; BAI Yunpeng, Email: oliverwhite@126.com

Keywords：

Coronary artery bypass grafting; complete revascularization; major adverse cardiac and cerebrovascular events; inverse probability weighting Foundation item: Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK-042A).

DOI：

10.7507/1007-4848.202408059

Video：

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Objective To compare postoperative survival rates and the incidence of adverse events in patients with three-vessel disease undergoing complete versus incomplete revascularization during coronary artery bypass grafting (CABG). Methods A retrospective analysis was conducted on patient data from Tianjin Chest Hospital who underwent primary isolated CABG surgery between 2019 and 2020. Patients were divided into a complete revascularization group and an incomplete revascularization group based on the revascularization status after surgery. Inverse probability of treatment weighting (IPTW) was used for risk adjustment. Results A total of 1 419 patients were included in the study, with 1 086 (76.5%) undergoing complete revascularization. IPTW analysis showed that complete revascularization could reduce the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) [HR=0.596, 95%CI (0.404, 0.880), P=0.010] and angina [HR=0.560, 95%CI (0.377, 0.823), P=0.004]. Conclusion In patients with multivessel coronary artery disease, complete revascularization may be associated with improved patient outcomes.

1.	Head SJ, Milojevic M, Daemen J, et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: A pooled analysis of individual patient data. Lancet, 2018, 391(10124): 939-948.
2.	ZHANG H, CHANG R. Effects of exercise after percutaneous coronary intervention on cardiac function and cardiovascular adverse events in patients with coronary heart disease: Systematic review and meta-analysis. J Sports Sci Med, 2019, 18(2): 213-22.
3.	Mulukutla SR, Gleason TG, Sharbaugh M, et al. Coronary bypass versus percutaneous revascularization in multivessel coronary artery disease. Ann Thorac Surg, 2019, 108(2): 474-480.
4.	Jones EL, Craver JM, Guyton RA, et al. Importance of complete revascularization in performance of the coronary bypass operation. Am J Cardiol, 1983, 51(1): 7-12.
5.	Buda AJ, Macdonald IL, Anderson M, et al. Long-term results following coronary bypass operation. Importance of preoperative actors and complete revascularization. J Thorac Cardiovasc Surg, 1981, 82(3): 383-90.
6.	Leviner DB, Torregrossa G, Puskas JD. Incomplete revascularization: What the surgeon needs to know. Ann Cardiothorac Surg, 2018, 7(4): 463-469.
7.	Omer S, Cornwell LD, Rosengart TK, et al. Completeness of coronary revascularization and survival: Impact of age and off-pump surgery. J Thorac Cardiovasc Surg, 2014, 148(4): 1307-1315.
8.	Osswald BR, Blackstone EH, Tochtermann U, et al. Does the completeness of revascularization affect early survival after coronary artery bypass grafting in elderly patients? Eur J Cardiothorac Surg, 2001, 20(1): 120-125.
9.	Kleisli T, Cheng W, Jacobs MJ, et al. In the current era, complete revascularization improves survival after coronary artery bypass surgery. J Thorac Cardiovasc Surg, 2005, 129(6): 1283-1291.
10.	Melby SJ, Saint LL, Balsara K, et al. Complete coronary revascularization improves survival in octogenarians. Ann Thorac Surg, 2016, 102(2): 505-511.
11.	Desai RJ, Franklin JM. Alternative approaches for confounding adjustment in observational studies using weighting based on the propensity score: a primer for practitioners. BMJ, 2019 Oct 23: 367: l5657.
12.	Garcia S, Sandoval Y, Roukoz H, et al. Outcomes after complete versus incomplete revascularization of patients with multivessel coronary artery disease: A meta-analysis of 89, 883 patients enrolled in randomized clinical trials and observational studies. J Am Coll Cardiol, 2013, 62(16): 1421-1431.
13.	Rastan AJ, Walther T, Falk V, et al. Does reasonable incomplete surgical revascularization affect early or long-term survival in patients with multivessel coronary artery disease receiving left internal mammary artery bypass to left anterior descending artery? Circulation, 2009, 120(11 Suppl): S70-77.
14.	van den Brand MJ, Rensing BJ, Morel MA, et al. The effect of completeness of revascularization on event-free survival at one year in the ARTS trial. J Am Coll Cardiol, 2002, 39(4): 559-564.
15.	Vo TX, Glineur D, Ruel M. Commentary: Complete revascularization in coronary artery bypass grafting-sometimes it pays to be conservative. J Thorac Cardiovasc Surg, 2023, 166(1): 115-116.16.
16.	Rosenblum JM, Binongo J, Wei J, et al. Priorities in coronary artery bypass grafting: Is midterm survival more dependent on completeness of revascularization or multiple arterial grafts? J Thorac Cardiovasc Surg, 2021, 161(6): 2070-2078.
17.	Kieser TM, Curran HJ, Rose MS, et al. Arterial grafts balance survival between incomplete and complete revascularization: a series of 1000 consecutive coronary artery bypass graft patients with 98% arterial grafts. J Thorac Cardiovasc Surg, 2014, 147(1): 75-83.
18.	Gössl M, Faxon DP, Bell MR, et al. Complete versus incomplete revascularization with coronary artery bypass graft or percutaneous intervention in stable coronary artery disease. Circ Cardiovasc Interv, 2012, 5(4): 597-604.
19.	Tian M, Xu B, Chen L, et al. Outcomes of quantitative flow ratio-based functional incomplete revascularization after coronary artery bypass grafting surgery. J Thorac Cardiovasc Surg, 2024, 168(2): 548-558.
20.	Ong AT, Serruys PW. Complete revascularization: Coronary artery bypass graft surgery versus percutaneous coronary intervention. Circulation, 2006, 114(3): 249-255.
21.	Bianco V, Kilic A, Aranda-Michel E, et al. Complete revascularization during coronary artery bypass grafting is associated with reduced major adverse events. J Thorac Cardiovasc Surg, 2023, 166(1): 104-113.
22.	Ford TJ, Berry C. Angina: Contemporary diagnosis and management. Heart, 2020, 106(5): 387-398.

1. Head SJ, Milojevic M, Daemen J, et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: A pooled analysis of individual patient data. Lancet, 2018, 391(10124): 939-948.
2. ZHANG H, CHANG R. Effects of exercise after percutaneous coronary intervention on cardiac function and cardiovascular adverse events in patients with coronary heart disease: Systematic review and meta-analysis. J Sports Sci Med, 2019, 18(2): 213-22.
3. Mulukutla SR, Gleason TG, Sharbaugh M, et al. Coronary bypass versus percutaneous revascularization in multivessel coronary artery disease. Ann Thorac Surg, 2019, 108(2): 474-480.
4. Jones EL, Craver JM, Guyton RA, et al. Importance of complete revascularization in performance of the coronary bypass operation. Am J Cardiol, 1983, 51(1): 7-12.
5. Buda AJ, Macdonald IL, Anderson M, et al. Long-term results following coronary bypass operation. Importance of preoperative actors and complete revascularization. J Thorac Cardiovasc Surg, 1981, 82(3): 383-90.
6. Leviner DB, Torregrossa G, Puskas JD. Incomplete revascularization: What the surgeon needs to know. Ann Cardiothorac Surg, 2018, 7(4): 463-469.
7. Omer S, Cornwell LD, Rosengart TK, et al. Completeness of coronary revascularization and survival: Impact of age and off-pump surgery. J Thorac Cardiovasc Surg, 2014, 148(4): 1307-1315.
8. Osswald BR, Blackstone EH, Tochtermann U, et al. Does the completeness of revascularization affect early survival after coronary artery bypass grafting in elderly patients? Eur J Cardiothorac Surg, 2001, 20(1): 120-125.
9. Kleisli T, Cheng W, Jacobs MJ, et al. In the current era, complete revascularization improves survival after coronary artery bypass surgery. J Thorac Cardiovasc Surg, 2005, 129(6): 1283-1291.
10. Melby SJ, Saint LL, Balsara K, et al. Complete coronary revascularization improves survival in octogenarians. Ann Thorac Surg, 2016, 102(2): 505-511.
11. Desai RJ, Franklin JM. Alternative approaches for confounding adjustment in observational studies using weighting based on the propensity score: a primer for practitioners. BMJ, 2019 Oct 23: 367: l5657.
12. Garcia S, Sandoval Y, Roukoz H, et al. Outcomes after complete versus incomplete revascularization of patients with multivessel coronary artery disease: A meta-analysis of 89, 883 patients enrolled in randomized clinical trials and observational studies. J Am Coll Cardiol, 2013, 62(16): 1421-1431.
13. Rastan AJ, Walther T, Falk V, et al. Does reasonable incomplete surgical revascularization affect early or long-term survival in patients with multivessel coronary artery disease receiving left internal mammary artery bypass to left anterior descending artery? Circulation, 2009, 120(11 Suppl): S70-77.
14. van den Brand MJ, Rensing BJ, Morel MA, et al. The effect of completeness of revascularization on event-free survival at one year in the ARTS trial. J Am Coll Cardiol, 2002, 39(4): 559-564.
15. Vo TX, Glineur D, Ruel M. Commentary: Complete revascularization in coronary artery bypass grafting-sometimes it pays to be conservative. J Thorac Cardiovasc Surg, 2023, 166(1): 115-116.16.
16. Rosenblum JM, Binongo J, Wei J, et al. Priorities in coronary artery bypass grafting: Is midterm survival more dependent on completeness of revascularization or multiple arterial grafts? J Thorac Cardiovasc Surg, 2021, 161(6): 2070-2078.
17. Kieser TM, Curran HJ, Rose MS, et al. Arterial grafts balance survival between incomplete and complete revascularization: a series of 1000 consecutive coronary artery bypass graft patients with 98% arterial grafts. J Thorac Cardiovasc Surg, 2014, 147(1): 75-83.
18. Gössl M, Faxon DP, Bell MR, et al. Complete versus incomplete revascularization with coronary artery bypass graft or percutaneous intervention in stable coronary artery disease. Circ Cardiovasc Interv, 2012, 5(4): 597-604.
19. Tian M, Xu B, Chen L, et al. Outcomes of quantitative flow ratio-based functional incomplete revascularization after coronary artery bypass grafting surgery. J Thorac Cardiovasc Surg, 2024, 168(2): 548-558.
20. Ong AT, Serruys PW. Complete revascularization: Coronary artery bypass graft surgery versus percutaneous coronary intervention. Circulation, 2006, 114(3): 249-255.
21. Bianco V, Kilic A, Aranda-Michel E, et al. Complete revascularization during coronary artery bypass grafting is associated with reduced major adverse events. J Thorac Cardiovasc Surg, 2023, 166(1): 104-113.
22. Ford TJ, Berry C. Angina: Contemporary diagnosis and management. Heart, 2020, 106(5): 387-398.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesComplete revascularization of triple-vessel disease in coronary artery bypass grafting reduces postoperative major adverse event rates： A retrospective cohort study

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