Multiarterial grafts improve the rate of early major adverse cardiac and cerebrovascular events in patients undergoing coronary revascularization: analysis of 12 615 patients with multivessel disease.

Abstract

OBJECTIVES:

Our goal was to compare the rates of in-hospital and 30-day major adverse cardiac and cerebrovascular events (MACCE) including death, stroke, myocardial infarction and repeat revascularization in patients with multivessel disease undergoing multiarterial (MultArt) coronary artery bypass grafting (CABG) with the left internal mammary artery/saphenous vein (LIMA/SV) CABG or percutaneous coronary intervention (PCI).

METHODS:

From 1 January 1993 to 31 December 2009, 12 615 consecutive patients underwent isolated primary CABG (n = 6667) with LIMA/SV (n = 5712) or MultArt (n = 955) or were treated by PCI (n = 5948) with balloon angioplasty (n = 1020), bare metal stent (n = 3242), and drug-eluting stent (n = 1686). We excluded patients with acute myocardial infarction. We matched the CABG group with the 3 PCI subgroups, and the PCI group with the 2 CABG subgroups. Multivariable analyses were used to evaluate the impact of CABG versus PCI and their subgroups on early MACCE.

RESULTS:

Unadjusted early MACCE were lower for MultArt (1.5%) than for LIMA/SV (4.5%, P < 0.001) and PCI (8.5%, P < 0.001). In matched analysis, CABG had lower early MACCE versus balloon angioplasty (4.7% vs 13.2%, P < 0.001), bare metal stent (4.3% vs 8.3%, P < 0.001), and drug-eluting stent (2.9% vs 5.5%, P = 0.008), as well as LIMA/SV versus PCI (4.6% vs 9.2%, P < 0.001) and MultArt versus PCI (1.8% vs 7.8%, P < 0.001). Stroke rate was similar in MultArt versus PCI (0.8% vs 0.3%, P = 0.18) but higher with LIMA/SV versus PCI (2.3% vs 0.4%, P < 0.001). In multivariable analysis, PCI (odds ratio 4.53, 95% confidence interval: 2.62-7.83; P < 0.001) and LIMA/SV (odds ratio 2.04, 95% confidence interval: 1.18-3.53; P < 0.011) were strong predictors of early MACCE compared with MultArt.

CONCLUSIONS:

MultArt confers the lowest rate of early MACCE.

• Authors: Chaim Locker, Hartzell V Schaff, Richard C Daly, Malcolm R Bell, Robert L Frye, John M Stulak, Sameh M Said, Joseph A Dearani, Lyle D Joyce, Kevin L Greason, Alberto Pochettino, Zhuo Li, Ryan J Lennon, Amir Lerman
• Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (Eur J Cardiothorac Surg) Vol. 52 Issue 4 Pg. 746-752 (Oct 01 2017) ISSN: 1873-734X [Electronic] Germany
• PMID: 28595326 (Publication Type: Comparative Study, Journal Article)
• Copyright: © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Topics

• Aged
• Analysis of Variance
• Angioplasty, Balloon, Coronary (adverse effects, methods, mortality)
• Cardiac Catheterization (methods)
• Cohort Studies
• Coronary Angiography (methods)
• Coronary Artery Bypass (adverse effects, methods, mortality)
• Coronary Artery Disease (diagnostic imaging, mortality, surgery)
• Databases, Factual
• Drug-Eluting Stents
• Female
• Follow-Up Studies
• Hospital Mortality
• Humans
• Logistic Models
• Male
• Mammary Arteries (transplantation)
• Middle Aged
• Multivariate Analysis
• Postoperative Complications (prevention & control)
• Propensity Score
• Retrospective Studies
• Risk Assessment
• Saphenous Vein (transplantation)
• Severity of Illness Index
• Stroke (etiology, prevention & control)
• Survival Rate
• Treatment Outcome