학술논문
Clinical Insights to Complete and Incomplete Surgical Revascularization in Atrial Fibrillation and Multivessel Coronary Disease
Document Type
article
Author
Michal Pasierski; Jakub Staromłyński; Janina Finke; Radoslaw Litwinowicz; Grzegorz Filip; Adam Kowalówka; Wojciech Wańha; Michalina Kołodziejczak; Natalia Piekuś-Słomka; Andrzej Łoś; Sebastian Stefaniak; Wojciech Wojakowski; Marek Jemielity; Jan Rogowski; Marek Deja; Dariusz Jagielak; Krzysztof Bartus; Silvia Mariani; Tong Li; Matteo Matteucci; Daniele Ronco; Federica Jiritano; Dario Fina; Gennaro Martucci; Paolo Meani; Giuseppe Maria Raffa; Artur Słomka; Pietro Giorgio Malvidni; Roberto Lorusso; Michal Zembala; Piotr Suwalski; Mariusz Kowalewski
Source
Frontiers in Cardiovascular Medicine, Vol 9 (2022)
Subject
Language
English
ISSN
2297-055X
Abstract
ObjectivesAlthough endorsed by international guidelines, complete revascularization (CR) with Coronary Artery Bypass Grafting (CABG) remains underused. In higher-risk patients such as those with pre-operative atrial fibrillation (AF), the effects of CR are not well studied.MethodsWe analyzed patients’ data from the HEIST (HEart surgery In AF and Supraventricular Tachycardia) registry. Between 2012 and 2020 we identified 4770 patients with pre-operative AF and multivessel coronary artery disease who underwent isolated CABG. We divided the cohort according to the completeness of the revascularization and used propensity score matching (PSM) to minimize differences between baseline characteristics. The primary endpoint was all-cause mortality.ResultsMedian follow-up was 4.7 years [interquartile range (IQR) 2.3–6.9]. PSM resulted in 1,009 pairs of complete and incomplete revascularization. Number of distal anastomoses varied, accounting for 3.0 + –0.6 vs. 1.7 + –0.6, respectively. Although early (< 24 h) and 30-day post-operative mortalities were not statistically different between non-CR and CR patients [Odds Ratio (OR) and 95% Confidence Intervals (CIs): 1.34 (0.46–3.86); P = 0.593, Hazard Ratio (HR) and 95% CIs: 0.88 (0.59–1.32); P = 0.542, respectively] the long term mortality was nearly 20% lower in the CR cohort [HR (95% CIs) 0.83 (0.71–0.96); P = 0.011]. This benefit was sustained throughout subgroup analyses, yet most accentuated in low-risk patients (younger i.e., < 70 year old, with a EuroSCORE II < 2%, non-diabetic) and when off-pump CABG was performed.ConclusionComplete revascularization in patients with pre-operative AF is safe and associated with improved survival. Particular survival benefit with CR was observed in low-risk patients undergoing off-pump CABG.