Impact of complete revascularization in coronary artery bypass grafting for ischemic cardiomyopathyCentral MessagePerspective
Masaro Nakae, MD,
Satoshi Kainuma, MD, PhD,
Koichi Toda, MD, PhD,
Yasushi Yoshikawa, MD, PhD,
Hiroki Hata, MD, PhD,
Daisuke Yoshioka, MD, PhD,
Takuji Kawamura, MD, PhD,
Ai Kawamura, MD, PhD,
Noriyuki Kashiyama, MD, PhD,
Takayoshi Ueno, MD, PhD,
Toru Kuratani, MD, PhD,
Haruhiko Kondoh, MD, PhD,
Arudo Hiraoka, MD, PhD,
Taichi Sakaguchi, MD, PhD,
Hidenori Yoshitaka, MD, PhD,
Yukitoshi Shirakawa, MD, PhD,
Toshiki Takahashi, MD, PhD,
Masayuki Sakaki, MD, PhD,
Takafumi Masai, MD, PhD,
Sho Komukai, PhD,
Tetsuhisa Kitamura, MD, MS, DPH,
Atsushi Hirayama, MD, MPH,
Yoshimitsu Shimomura, MD,
Shigeru Miyagawa, MD, PhD
Affiliations
Masaro Nakae, MD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Satoshi Kainuma, MD, PhD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Koichi Toda, MD, PhD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Yasushi Yoshikawa, MD, PhD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Hiroki Hata, MD, PhD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Daisuke Yoshioka, MD, PhD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Takuji Kawamura, MD, PhD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Ai Kawamura, MD, PhD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Noriyuki Kashiyama, MD, PhD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Takayoshi Ueno, MD, PhD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Toru Kuratani, MD, PhD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Haruhiko Kondoh, MD, PhD
Japan Organization of Occupational Health and Safety Osaka Rosai Hospital, Sakai, Osaka, Japan
Arudo Hiraoka, MD, PhD
Sakakibara Heart Institute of Okayama, Okayama, Japan
Taichi Sakaguchi, MD, PhD
Sakakibara Heart Institute of Okayama, Okayama, Japan
Hidenori Yoshitaka, MD, PhD
Sakakibara Heart Institute of Okayama, Okayama, Japan
Yukitoshi Shirakawa, MD, PhD
Osaka Police Hospital, Osaka, Osaka, Japan
Toshiki Takahashi, MD, PhD
Osaka Police Hospital, Osaka, Osaka, Japan
Masayuki Sakaki, MD, PhD
National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan
Takafumi Masai, MD, PhD
Sakurabashi Watanabe Hospital, Osaka, Osaka, Japan
Sho Komukai, PhD
Division of Biomedical Statistics, Department of Integrated Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Tetsuhisa Kitamura, MD, MS, DPH
Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Atsushi Hirayama, MD, MPH
Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Yoshimitsu Shimomura, MD
Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Shigeru Miyagawa, MD, PhD
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Address for reprints: Shigeru Miyagawa, MD, PhD, Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita, Osaka 565-0871, Japan.
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.
