J Korean Med Sci.  2012 Sep;27(9):1051-1056. 10.3346/jkms.2012.27.9.1051.

Mid-term Outcomes of Total Arterial Revascularization Versus Conventional Coronary Surgery in Isolated Three-Vessel Coronary Disease

• Chung JW
• Kim JB
• Jung SH
• Choo SJ
• Song H
• Chung CH
• Lee JW

• KMID: 1782138
• DOI: http://doi.org/10.3346/jkms.2012.27.9.1051

Abstract

Whether arterial conduits are superior to venous grafts in coronary artery bypassing has been debated. The aim of this study was to investigate clinical outcomes after total arterial revascularization versus conventional coronary bypassing using both arterial and venous conduits in isolated three-vessel coronary disease. Between 2003 and 2005, 503 patients who underwent isolated coronary artery bypass grafting for three-vessel coronary disease were enrolled. A total of 117 patients underwent total arterial revascularization (Artery group) whereas 386 patients were treated with arterial and venous conduits (Vein group). Major adverse outcomes (death, myocardial infarction, stroke and repeat revascularization) were compared. Clinical follow-up was complete in all patients with a mean duration of 6.1 +/- 0.9 yr. After adjustment for differences in baseline risk factors, risks of death (hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.51-1.82, P = 0.90), myocardial infarction (HR 0.20, 95% CI 0.02-2.63, P = 0.22), stroke (HR 1.29, 95% CI 0.35-4.72, P = 0.70), repeat revascularization (HR 0.64, 95% CI 0.26-1.55, P = 0.32) and the composite outcomes (HR 0.83, 95% CI 0.50-1.36, P = 0.45) were similar between two groups. Since the use of veins does not increase the risks of adverse outcomes compared with total arterial revascularization, a selection of the conduit should be more liberal.

Keyword

Coronary Artery Bypass Grafting; Arteries; Veins

MeSH Terms

Aged
Cohort Studies
*Coronary Artery Bypass
Coronary Disease/complications/mortality/*surgery
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Myocardial Infarction/etiology
Myocardial Revascularization
Prospective Studies
Risk Factors
Stroke/etiology
Treatment Outcome

Figure

• 

  Fig. 1 There were no significant differences in survival rate, freedom from reintervention and event-free survival rate between the Artery and the Vein groups in propensity score matched population. (A) Survival rate. (B) Freedom from reintervention. (C) Event-free survival rate.

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