Rate of Incomplete Revascularization Following Coronary Artery Bypass Grafting at a Single Institution Between 2007 and 2017

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Incomplete revascularization following coronary artery bypass grafting (CABG) is associated with increased repeat revascularization, myocardial infarction and death. Whether the rate of incomplete revascularization is increasing over time has not been previously described. All patients with multivessel coronary artery disease who underwent isolated and elective CABG at our Institution in 2007 (n = 291) were compared to patients who underwent CABG in 2017 (n = 290). A Revascularization Index Score was created to compare rates of incomplete revascularization between the 2 years based on the coronary anatomy and degree of stenosis. Comparison of the 2 years disclose that the rate of incomplete revascularization increased from 17.9% in 2007 to 28.3% in 2017 (p = 0.003) and was accompanied by a decline in the Revascularization Index Score from 0.73 to 0.67 (p = 0.005). Left ventricular function improved in both groups following CABG. Two-year cardiovascular mortality was significantly higher in the 2017 cohort compared to the 2007 cohort. These differences may be attributable to patient factors including more severe coronary artery disease associated with older age, greater incidence of smoking and previous percutaneous coronary intervention. In conclusion, the rate of incomplete revascularization following CABG significantly increased in 2017 compared to 2007 and was associated with higher cardiovascular mortality.

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Methods

This retrospective cohort study was approved by the Institutional Review Board of Allina Health and Abbott Northwestern Hospital. A review of patients with multi-vessel CAD was performed based on the date of CABG operations at the Minneapolis Heart Institute at Abbott Northwestern Hospital. Two cohorts were analyzed, a historical cohort consisting of all patients who underwent elective and solitary CABG in 2007 (n = 291) and a contemporary cohort consisting of all patients who underwent CABG in

Results

The historical cohort was composed of 291 consecutive patients who underwent elective and isolated CABG in 2007. The contemporary cohort was composed of 290 consecutive patients who underwent elective and isolated CABG in 2017.

In the historical cohort, 52 (17.9%) operations were classified as incomplete while in the contemporary cohort, 82 (28.3%) operations were classified as incomplete resulting in a significant increase in incomplete revascularization (p = 0.003) over the 10-year period (

Discussion

We observed that the incidence of incomplete revascularization following CABG significantly increased over a 10-year period (2007 to 2017) from 17% to 28%. This occurred despite a 50% decline in off-pump CABG in the 2017 group which has previously been associated with greater incomplete revascularization in several studies.6,12 Subjects in the 2007 group were more likely to be smokers and had a greater incidence of peripheral vascular disease while subjects in the 2017 cohort were older, more

Authors’ Contributions

Chase Soukup – data curation, investigation, writing-original draft. Christian Schmidt – formal analysis. Carmen Chan-Tram – investigation, data curation. Ross Garberich – formal analysis, methodology. Benjamin Sun – conceptualization, Investigation. Jay Traverse – conceptualization, data curation, Investigation, methodology, supervision, writing original draft.

Disclosures

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Chase Soukup reports financial support was provided by Minneapolis Heart Institute Foundation. Chase Soukup reports a relationship with Minneapolis Heart Institute Foundation that includes: funding grants.

Funding: Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.

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