Revascularization of occluded right coronary artery and outcome after coronary artery bypass grafting
Abstract
Objectives: The aim of the present study was to evaluate the results of isolated coronary artery bypass grafting (CABG) with or without revascularization of the occluded right coronary artery (RCA).
Methods: Patients undergoing isolated CABG were included in a prospective European multicenter registry. Outcomes were adjusted for imbalance in preoperative variables with propensity score matching analysis. Late outcomes were evaluated with Kaplan-Meier's method and competing risk analysis.
Results: Out of 2,948 included in this registry, 724 patients had a total occlusion of the RCA and were the subjects of this analysis. Occluded RCA was not revascularized in 251 (34.7%) patients with significant variability between centers. Among 245 propensity score-matched pairs, patients with and without revascularization of occluded RCA had similar early outcomes. The nonrevascularized RCA group had increased rates of 5-year all-cause mortality (17.7 vs. 11.7%, p = 0.039) compared with patients who had their RCA revascularized. The rates of myocardial infarction and repeat revascularization were only numerically increased but contributed to a significantly higher rate of MACCE (24.7 vs. 15.7%, p = 0.020) at 5 year among patients with nonrevascularized RCA.
Conclusions: In this multicenter study, one-third of totally occluded RCAs was not revascularized during isolated CABG for multivessel coronary artery disease. Failure to revascularize an occluded RCA in these patients increased the risk of all-cause mortality and MACCEs at 5 years.
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Subject
Coronary artery bypass grafting, Percutaneous coronary intervention, Myocardial infarction, Repeat revascularization, Right coronary artery, Major cardiac and cerebrovascular events
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Biancari, F., Dalén, M., Tauriainen, T., Gatti, G., Salsano, A., Santini, F., Feo, M., Zhang, Q., Mazzaro, E., Franzese, I., Bancone, C., Zanobini, M., Mäkikallio, T., Saccocci, M., Francica, A., Onorati, F., El-Dean, Z., & Mariscalco, G. (2023). Revascularization of Occluded Right Coronary Artery and Outcome After Coronary Artery Bypass Grafting. The Thoracic and cardiovascular surgeon, 10.1055/s-0043-1761625. Advance online publication. https://doi.org/10.1055/s-0043-1761625