Total Arterial Coronary Revascularisation is Associated with Lower Postoperative Major Adverse Cardiac and Cerebral Events

Abstract

Introduction: Total arterial revascularisation (TAR) with internal mammary artery (IMA) and radial artery (RA) may be associated better survival and freedom from major adverse cardiac and cerebral events (MACCE) compared to the standard approached of coronary artery bypass grafts (CABG) with single IMA and supplementary saphenous venous grafts (SIMA+SVG). Methods: Patients with primary CABG at Royal Melbourne Hospital, 1996-2004 were contacted via telephone or mail to assess MACCE (myocardial infarction (MI), stent insertion (PCI), redo CABG, and stroke). Only those had TAR or SIMA+SVG with postoperative duration > 10 years were included. To reduce treatment selection bias, 1 to 1 nearest-neighbour propensity score matching (PSM) with random matching with calliper 0.2*SD were applied. Preoperative covariates were smoking, diabetes, hypercholesterolemia, hypertension, obesity, any concomitant heart valve disease, positive family history and renal failure. Results: 215 patients completed follow up data, TAR (170) and SIMA+SVG (45). Age at follow up was 77.3±9.9 yr with 82.5% males, 93% isolated CABG. 15 patients were excluded (redo CABG = 12, incomplete preoperative data = 3). Two groups were formed (TAR (156) and SIMA+SVG (44), and PSM yielded 41 in each group with. Balance covariates were achieved with absolute standardised difference < 0.25. The proportion of patients with at least one MACCE event was lower for TAR than for SIMA+SVG, 12 vs. 39%, p=0.010. MACCE subgroup data for TAR vs. SIMA+SVG was: MI 2 vs. 12%, PCI 7 vs. 24%, redo cardiac surgery 0 vs. 0%, stroke 5 vs. 10%. Conclusion: TAR has a lower MACCE compared to SIMA+SVG.