JTCVS Open (Sep 2023)

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

Journal volume & issue
Vol. 15
pp. 211 – 219

Abstract

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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.

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