Detection of Gender Differences in Incomplete Revascularization after Coronary Artery Bypass Surgery Varies with Classification Technique

Background. Incomplete revascularization negatively affects survival after coronary artery bypass surgery (CABG). Since gender and classification technique might impact outcome and reporting, we investigated their effect on revascularization patterns and mortality.Methods. A cohort of bypass patients (N=1545, 23% women) was enrolled prospectively. The degree of revascularization was determined as mathematical difference between affected vessels upon diagnosis and number of grafts or the surgeon’s rating on the case file.Results. Although men displayed more triple-vessel disease, they obtained complete revascularization more frequently than women (85% versus 77%,P<0.001). The two calculation methods identified analogous percentages of incompletely revascularized patients, yet there was only a 50% overlap between the two groups. Mathematically, more women, older patients, and patients with NYHA class III/IV appeared incompletely revascularized, while the surgeons identified more patients undergoing technically challenging procedures. Regardless of the definition, incompleteness was a significant risk factor for mortality in both genders (mathematical calculation: HR 2.62, 95% CI 1.76–3.89,P<0.001; surgeon: HR 2.04, 95% CI 1.35–3.89,P=0.001).Conclusions. Given the differences in identification patterns, we advise that the mathematical calculation be performed after-procedure in all patients regardless of the surgeons’ rating to uncover additional subjects at increased risk.

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Abstract 13346: The Rate of Incomplete Revascularization Following Coronary Artery Bypass Surgery Has Increased Over Time

Circulation ◽

10.1161/circ.142.suppl_3.13346 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Chase R Soukup ◽

Christian W Schmidt ◽

Carmen Chan-Tram ◽

Ross F Garberich ◽

Benjamin Sun ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Complete Revascularization ◽

Incomplete Revascularization ◽

Artery Disease ◽

Over Time

Introduction: Incomplete revascularization following coronary artery bypass surgery (CABG) is associated with increased repeat revascularization, myocardial infarction and death. However, whether the rate of incomplete revascularization is increasing over time has not been previously described. Methods: We performed a retrospective review of consecutive patients who underwent elective and isolated CABG for multi-vessel coronary artery disease in 2007 (n=291) and in 2017 (n=290) at a single Institution. All coronary angiograms and CABG operative reports were reviewed and a Revascularization Index Score (RIS) was created to compare rates of incomplete revascularization between the two time periods based on the coronary anatomy and degree of stenosis. Thus a patient with complete revascularization will have an RIS score of 1.0 while a patient who has 3 of 4 eligible vessels bypassed will have an RIS score of 0.75. Results: Over a 10 year period, the rate of incomplete revascularization increased from 17.9% to 28.3% (p = 0.003) and was accompanied by a decline in the RIS score from 0.73 to 0.67 (p= 0.005). Mortality significantly increased over time with incomplete compared to complete revascularization in the 2007 cohort. Conclusions: The incidence of incomplete revascularization following CABG significantly increased over a 10-year time period between 2007 and 2017. These differences may be attributable to patient factors including more severe coronary artery disease associated with older age, greater incidence of smoking and previous PCI. In line with previous. meta-analyses, the incidence of mortality over time was higher in those patients with incomplete compared to those with complete revascularization. These results suggest that patients with incomplete revascularization represents an important target for the development of novel therapies.

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AS-002 Impact of Angiographic Complete Revascularization after Drug-Eluting Stent Implantation or Coronary Artery Bypass Surgery for Multivessel Coronary Disease

The American Journal of Cardiology ◽

10.1016/j.amjcard.2011.02.311 ◽

2011 ◽

Vol 107 (8) ◽

pp. 1A

Author(s):

Young-Hak Kim ◽

Chang Hoon Lee ◽

Ki Won Hwang ◽

Gyung-Min Park ◽

Sung Won Cho ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Coronary Disease ◽

Stent Implantation ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Drug Eluting Stent ◽

Complete Revascularization ◽

Drug Eluting

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Preoperative Aspirin Therapy Is Associated With Improved Postoperative Outcomes in Patients Undergoing Coronary Artery Bypass Grafting

Circulation ◽

10.1161/circulationaha.104.522805 ◽

2005 ◽

Vol 112 (9_supplement) ◽

Author(s):

Kevin A. Bybee ◽

Brian D. Powell ◽

Uma Valeti ◽

A. Gabriela Rosales ◽

Stephen L. Kopecky ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Blood Product ◽

Artery Bypass ◽

Aspirin Therapy ◽

Blood Product Transfusion ◽

Cerebrovascular Events ◽

Increased Risk

Background— Aspirin is beneficial in the setting of atherosclerotic cardiovascular disease. There are limited data evaluating preoperative aspirin administration preceding coronary artery bypass grafting and associated postoperative outcomes. Methods and Results— Using prospectively collected data from 1636 consecutive patients undergoing first-time isolated coronary artery bypass surgery at our institution from January 2000 through December 2002, we evaluated the association between aspirin usage within the 5 days preceding coronary bypass surgery and risk of adverse in-hospital postoperative events. A logistic regression model, which included propensity scores, was used to adjust for remaining differences between groups. Overall, there were 36 deaths (2.2%) and 48 adverse cerebrovascular events (2.9%) in the postoperative hospitalization period. Patients receiving preoperative aspirin (n=1316) had significantly lower postoperative in-hospital mortality compared with those not receiving preoperative aspirin [1.7% versus 4.4%; adjusted odds ratio (OR), 0.34; 95% CI, 0.15 to 0.75; P =0.007]. Rates of postoperative cerebrovascular events were similar between groups (2.7% versus 3.8%; adjusted OR, 0.67; 95% CI, 0.32 to 1.50; P =0.31). Preoperative aspirin therapy was not associated with an increased risk of reoperation for bleeding (3.5% versus 3.4%; P =0.96) or requirement for postoperative blood product transfusion (adjusted OR, 1.17; 95% CI, 0.88 to 1.54; P =0.28). Conclusions— Aspirin usage within the 5 days preceding coronary artery bypass surgery is associated with a lower risk of postoperative in-hospital mortality and appears to be safe without an associated increased risk of reoperation for bleeding or need for blood product transfusion.

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In the current era, complete revascularization improves survival after coronary artery bypass surgery

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2004.12.034 ◽

2005 ◽

Vol 129 (6) ◽

pp. 1283-1291 ◽

Cited By ~ 108

Author(s):

Thomas Kleisli ◽

Wen Cheng ◽

Milagros J. Jacobs ◽

James Mirocha ◽

Michele A. DeRobertis ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Complete Revascularization

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Effect of Revascularization on Coronary Chronic Total Occlusion in Patients Undergoing Coronary Artery Bypass Grafting

10.21203/rs.3.rs-142172/v1 ◽

2021 ◽

Author(s):

Yun Seok Kim ◽

Jiyun Lee ◽

Hwan Wook Kim ◽

Joonkyu Kang ◽

Hyun Song ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Total Occlusion ◽

Chronic Total Occlusions ◽

Cerebrovascular Events ◽

Incomplete Revascularization ◽

Overall Mortality

Abstract Background: Bypass grafting for chronic total occlusions remains surgically challenging and controversial. Therefore, we evaluated the incidence and clinical outcomes of revascularization on chronic total occlusions undergoing coronary artery bypass surgery.Methods: Among 828 patients who underwent isolated coronary artery bypass surgery from January 2010 to December 2018, 245 patients (29.5%) diagnosed with at least one chronic total occlusion were included and retrospectively reviewed. Primary endpoints were 30-day and overall mortality. Secondary endpoint was the composite outcome of major adverse cardiac and cerebrovascular events. Results: With a mean follow-up of 56.6 ± 6.5 months in 245 patients with chronic total occlusions, 51 patients (20.9%) received incomplete revascularization for chronic total occlusions. Risk factor analysis showed that incomplete revascularization was associated with increased 30-day (odds ratio 8.62; 95% confidence interval (CI) 1.64 – 50; p = 0.011) and overall mortality (hazard ratio (HR) 2.13; 95% CI 1.07 – 4.21; p = 0.03). ICR also increased the risk of major adverse cardiac and cerebrovascular events (HR 1.98; 95% CI 1.12 – 3.54; p = 0.01). Freedom from overall mortality was 92.8%, 90.4%, and 86.8% in the complete revascularization group, and 86.3%, 80.0%, and 72.7% in the incomplete revascularization group, at 1, 3, and 5 years, respectively (p = 0.004).Conclusions: In patients with chronic total occlusions undergoing coronary artery bypass surgery, the rate of incomplete revascularization was 20.9%, and it significantly increased the risk of mortality and major adverse cardiac and cerebrovascular events. Further studies in a large cohort are needed.

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