Department of Cardiac Surgery, The University of Tokyo Hospital.
Department of Cardiovascular Surgery, Mitsui Memorial Hospital.
Circ J. 2018 Dec 25;83(1):122-129. doi: 10.1253/circj.CJ-18-0653. Epub 2018 Oct 27.
The long-term outcomes of complete revascularization (CR) in patients with left ventricular (LV) dysfunction undergoing coronary artery bypass grafting (CABG) remain unclear.
We evaluated a consecutive series of 111 patients with LV ejection fraction ≤35% who underwent isolated first-time CABG: 63 underwent CR and 48 underwent incomplete revascularization (IR). At a median follow-up of 10.1 years, the rates of death from any cause, cardiac death, and major adverse cardiac and cerebrovascular events (MACCE) were significantly greater in the IR group. After adjusting for propensity score, no significant difference was found between the CR and IR groups regarding death from any cause (hazard ratio [HR], 1.45; 95% CI: 0.75-2.81; P=0.271) and cardiac death (HR, 1.45; 95% CI: 0.68-3.10; P=0.337). In contrast, IR increased the risk of MACCE (HR, 1.92; 95% CI: 1.08-3.41; P=0.027), which was principally attributed to an increased risk of repeat revascularization (HR, 3.92; 95% CI: 1.34-11.44; P=0.013).
Although IR was not significantly associated with an increased risk of long-term mortality in patients with LV dysfunction who underwent CABG, CR might reduce the risks of repeat revascularization and subsequent MACCE.
左心室（LV）功能障碍患者行冠状动脉旁路移植术（CABG）后完全血运重建（CR）的长期结局仍不清楚。
我们评估了 111 例 LV 射血分数≤35%的首次孤立性 CABG 患者的连续系列：63 例接受 CR，48 例接受不完全血运重建（IR）。中位随访 10.1 年后，IR 组的任何原因死亡率、心源性死亡率和主要心脏和脑血管不良事件（MACCE）发生率显著更高。在校正倾向评分后，CR 组和 IR 组之间任何原因死亡（风险比[HR]，1.45；95%CI：0.75-2.81；P=0.271）和心源性死亡（HR，1.45；95%CI：0.68-3.10；P=0.337）无显著差异。相比之下，IR 增加了 MACCE 的风险（HR，1.92；95%CI：1.08-3.41；P=0.027），这主要归因于再次血运重建的风险增加（HR，3.92；95%CI：1.34-11.44；P=0.013）。
尽管 IR 与 LV 功能障碍患者 CABG 后长期死亡率的增加无显著相关性，但 CR 可能降低再次血运重建和随后 MACCE 的风险。
