Impact of complete revascularization in coronary artery bypass grafting for ischemic cardiomyopathy.

Abstract

Objective:

In patients with ischemic cardiomyopathy, coronary artery bypass grafting ensures better survival than medical therapy. However, the long-term clinical impact of complete revascularization remains unclear. This observational study aimed to evaluate the effects of complete revascularization on long-term survival and left ventricular functional recovery in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting.

Methods:

We retrospectively reviewed outcomes of 498 patients with ischemic cardiomyopathy who underwent complete (n = 386) or incomplete (n = 112) myocardial revascularization between 1993 and 2015. The baseline characteristics were adjusted using inverse probability of treatment weighting to reduce the impact of treatment bias and potential confounding. The mean follow-up duration was 77.2 ± 42.8 months in survivors.

Results:

The overall 5-year survival rate (complete revascularization, 72.5% vs incomplete revascularization, 57.9%, P = .03) and freedom from all-cause death and/or readmission due to heart failure (54.5% vs 40.1%, P = .007) were significantly greater in patients with complete revascularization than those with incomplete revascularization. After adjustments using inverse probability of treatment weighting, the complete revascularization group demonstrated a lower risk of all-cause death (hazard ratio, 0.61; 95% confidence interval, 0.43-0.86; P = .005) and composite adverse events (hazard ratio, 0.59; 95% confidence interval, 0.44-0.79; P < .001) and a greater improvement in the left ventricular ejection fraction 1-year postoperatively (absolute change: 11.0 ± 11.9% vs 8.3 ± 11.4%, interaction effect P = .05) than the incomplete revascularization group.

Conclusions:

In patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting, complete revascularization was associated with better long-term outcomes and greater left ventricular functional recovery and should be encouraged whenever possible.

• Authors: Masaro Nakae, Satoshi Kainuma, Koichi Toda, Yasushi Yoshikawa, Hiroki Hata, Daisuke Yoshioka, Takuji Kawamura, Ai Kawamura, Noriyuki Kashiyama, Takayoshi Ueno, Toru Kuratani, Haruhiko Kondoh, Arudo Hiraoka, Taichi Sakaguchi, Hidenori Yoshitaka, Yukitoshi Shirakawa, Toshiki Takahashi, Masayuki Sakaki, Takafumi Masai, Sho Komukai, Tetsuhisa Kitamura, Atsushi Hirayama, Yoshimitsu Shimomura, Shigeru Miyagawa, Osaka Cardiovascular Surgery Research (OSCAR) Group
• Journal: JTCVS open (JTCVS Open) Vol. 15 Pg. 211-219 (Sep 2023) ISSN: 2666-2736 [Electronic] Netherlands
• PMID: 37808015 (Publication Type: Journal Article)
• Copyright: © 2023 The Author(s).