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

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

doi:10.1016/j.xjon.2023.04.008

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

JTCVS Open. 2023 Apr 20:15:211-219. doi: 10.1016/j.xjon.2023.04.008. eCollection 2023 Sep.

Authors

Masaro Nakae¹, Satoshi Kainuma¹, Koichi Toda¹, Yasushi Yoshikawa¹, Hiroki Hata¹, Daisuke Yoshioka¹, Takuji Kawamura¹, Ai Kawamura¹, Noriyuki Kashiyama¹, Takayoshi Ueno¹, Toru Kuratani¹, Haruhiko Kondoh², Arudo Hiraoka³, Taichi Sakaguchi³, Hidenori Yoshitaka³, Yukitoshi Shirakawa⁴, Toshiki Takahashi⁴, Masayuki Sakaki⁵, Takafumi Masai⁶, Sho Komukai⁷, Tetsuhisa Kitamura⁸, Atsushi Hirayama⁹, Yoshimitsu Shimomura⁸, Shigeru Miyagawa¹; Osaka Cardiovascular Surgery Research (OSCAR) Group

Affiliations

¹ Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
² Japan Organization of Occupational Health and Safety Osaka Rosai Hospital, Sakai, Osaka, Japan.
³ Sakakibara Heart Institute of Okayama, Okayama, Japan.
⁴ Osaka Police Hospital, Osaka, Osaka, Japan.
⁵ National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan.
⁶ Sakurabashi Watanabe Hospital, Osaka, Osaka, Japan.
⁷ Division of Biomedical Statistics, Department of Integrated Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
⁸ Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
⁹ Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.

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.

Keywords: complete revascularization; coronary artery bypass grafting; ischemic cardiomyopathy; left ventricular function; long-term follow-up.