Long-term follow-up of total arterial versus conventional and hybrid myocardial revascularization: A propensity score matched analysis

Purpose

To evaluate the impact of the revascularization technique (by means of conventional, total arterial or hybrid myocardial revascularization) in patients with multivessel coronary artery disease.

Methods

A propensity-score analysis of patients undergoing myocardial revascularization from 1998 to 2012 was performed based on the surgical technique utilized, either total arterial (Group1, G1,n°?=?89), conventional CABG(LIMA on LAD plus veins, Group2, G2,n°?=?89), or hybrid revascularization (LIMA on LAD plus PTCA on non-LAD vessels, Group3, G3, n°?=?89). Primary end-points were overall survival and cardiac-related death while secondary composite end-point was survival freedom from major adverse cardiac and cerebrovascular events (MACCEs) defined as myocardial infarction, cardiac death, stroke and repeated target vessel revascularization.

Results

Study population was mostly affected by double-vessels disease (G1?=?2.35 vs G2?=?2.3 vs G3?=?2.4, p?=?0.14) with a preserved LV function(G1?=?48% vs G2?=?49% vs G3?=?50%, p?=?0.12). Hospital mortality was 0% in all groups. At a mean follow-up of 6?±?2?years overall survival was significantly better in patients receiving total arterial myocardial revascularization (G1?=?90.4?±?3.5% vs G2?=?82.3?±?4.2% vs G3?=?82.1?±?5.9%, p?=?0.049) as well as freedom from MACCEs (G1?=?95.2?±?2.4% vs G2?=?86.5?±?4% vs G3?=?68?±?6.9%, p?=?0.001) while survival free from cardiac-related death was similar(G1?=?97.7?±?1.6% vs G2?=?95.1?±?2.4% vs G3?=?89.5?±?5.4%, p?=?0.08). Conversely, at 10?years follow-up only freedom from MACCEs was significantly better in patients of Group 1(G1?=?78.9?±?8.6% vs G2?=?72.4?±?5.7% vs G3?=?52?±?8.7%, p?<?0.001).

Conclusions

Total arterial revascularization provides improved outcomes at mid and long term follow-up compared with conventional or hybrid revascularization. The latter technique is particularly associated with a significantly higher incidence of late myocardial infarction and repeat revascularization.