Complete Coronary Revascularization and Outcomes in Patients Who Underwent Coronary Artery Bypass Grafting: Insights from The REGROUP Trial - 31/03/24
, Eileen M. Stock, PhD b, Brack Hattler, MD c, Faisal G. Bakaeen, MD d, Scott Kinlay, MD e, Jacqueline A. Quin, MD f, Miguel Haime, MD f, Kousick Biswas, PhD b, Marco A. Zenati, MD a, fRésumé |
There is growing evidence in support of coronary complete revascularization (CR). Nonetheless, there is no universally accepted definition of CR in patients who undergo coronary bypass grafting surgery (CABG). We sought to investigate the outcomes of CR, defined as surgical revascularization of any territory supplied by a suitable coronary artery with ≥50% stenosis. We performed a preplanned subanalysis in the Randomized Trial of Endoscopic or Open Saphenous Vein Graft Harvesting (REGROUP) clinical trial cohort. Of 1,147 patients who underwent CABG, 810 (70.6%) received CR. The primary outcome was a composite of major adverse cardiac events (MACEs), including death from any cause, nonfatal myocardial infarction, or repeat revascularization over a median 4.7 years of follow-up. MACE occurred in 175 patients (21.6%) in the CR group and 86 patients (25.5%) in the incomplete revascularization (IR) group (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.67 to 1.13, p = 0.29). A total of 97 patients (12.0%) in the CR group and 48 patients (14.2%) in the IR group died (HR 0.93, 95% CI 0.65 to 1.32, p = 0.67); nonfatal myocardial infarction occurred in 49 patients (6.0%) in the CR group and 30 patients (8.9%) in the IR group (HR 0.76, 95% CI 0.48 to 1.2, p = 0.24), and repeat revascularization occurred in 62 patients (7.7%) in the CR group and 39 patients (11.6%) in the IR group (HR 0.64; 95% CI 0.42 to 0.95, p = 0.027). In conclusion, in patients with a great burden of co-morbidities who underwent CABG in the REGROUP trial over a median follow-up period of a median 4.7 years, CR was associated with similar MACE rates but a reduced risk of repeat revascularization. Longer-term follow-up is warranted.
Le texte complet de cet article est disponible en PDF.Keywords : complete revascularization, coronary artery bypass grafting (CABG), coronary artery disease, veteran affairs
Plan
| Read at the 103rd Annual Meeting of the American Association for Thoracic Surgery, Los Angeles, California, May 6 to 9, 2023. |
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| Institutional review board: The study (Cooperative Studies Program 588 institutional review board number 2694) was approved August 14, 2013—with first subjects enrolled September 5, 2013 and last subject follow-up completed April 18, 2018. All patients signed informed consent. |
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| Funding: This study was supported by an award from the Office for Research and Development, Cooperative Studies Program (number 588) of the Department of Veterans Affairs, Washington, District of Columbia, and funded by the Cooperative Studies Program, Department of Veterans Affairs; REGROUP (Cooperative Studies Program number 588), ClinicalTrials.gov NCT01850082. |
Vol 217
P. 127-135 - avril 2024 Retour au numéro
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