Arayawudhikul Nuttapon, Ushioda Ryohei, Isa Hideki, Yoongtong Dit, Sakboon Boonsap, Cheewinmethasiri Jaroen, Lokeskrawee Thanin, Patumanond Jayanton, Lawanaskol Suppachai, Kamiya Hiroyuki
Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Lampang Hospital, Lampang, Thailand.
Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan.
Front Cardiovasc Med. 2025 May 1;12:1598770. doi: 10.3389/fcvm.2025.1598770. eCollection 2025.
To assess whether total arterial revascularization (TAR) offers survival and freedom from major adverse cardiac or cerebrovascular events (MACCE) benefit in elderly patients with multivessel coronary artery disease undergoing off-pump coronary artery bypass grafting (OPCAB), as compared to using a single internal thoracic artery (ITA) with additional saphenous vein graft (SVG).
We retrospectively analyzed 598 patients aged >70 years who underwent coronary revascularization from August 2017-July 2023. After excluding high-risk patients and those with SVG plus more than two arterial grafts, 428 patients remained (101, TAR group; 327, single ITA + SVG group). A propensity score was used to create the TAR and single ITA + SVG groups with 1:1 ratio (100 patients in each group). Moreover, matching was performed based on eight covariates with preoperative clinical characteristics.
The unmatched cohort had 70 (69.3%) and 178 (54.4%) men in the TAR and ITA + SVG groups, respectively (mean age, 74.1 ± 3.5 and 75.2 ± 4.2 years, respectively). After matching, both groups had similar demographics. The survival ( = 0.410) and MACCE-free rates ( = 0.494) over 5 years were not significantly different between the two groups. Univariable analysis showed that TAR [hazard ratio (HR) = 0.74, 95% confidence interval (CI) = 0.44-1.22, = 0.233] and complete revascularization (HR = 0.61, 95%CI = 0.34-1.09, = 0.094) were not significant risk factors for long-term mortality.
Elderly patients who underwent OPCAB with total arterial grafting did not show survival or free-MACCE benefits for over 5 years.
评估与使用单根胸廓内动脉（ITA）加用大隐静脉移植血管（SVG）相比，完全动脉化血运重建（TAR）在接受非体外循环冠状动脉旁路移植术（OPCAB）的老年多支冠状动脉疾病患者中是否能带来生存获益以及避免主要不良心脏或脑血管事件（MACCE）。
我们回顾性分析了2017年8月至2023年7月期间接受冠状动脉血运重建的598例年龄大于70岁的患者。在排除高危患者以及使用了SVG加两根以上动脉移植血管的患者后，剩余428例患者（101例在TAR组；327例在单根ITA + SVG组）。采用倾向评分法以1:1的比例创建TAR组和单根ITA + SVG组（每组100例患者）。此外，基于八个术前临床特征协变量进行匹配。
未匹配队列中，TAR组和ITA + SVG组分别有70例（69.3%）和178例（54.4%）男性（平均年龄分别为74.1±3.5岁和75.2±4.2岁）。匹配后，两组的人口统计学特征相似。两组在5年期间的生存率（P = 0.410）和无MACCE率（P = 0.494）无显著差异。单因素分析显示，TAR[风险比（HR）= 0.74，95%置信区间（CI）= 0.44 - 1.22，P = 0.233]和完全血运重建（HR = 0.61，95%CI = 0.34 - 1.09，P = 0.094）不是长期死亡率的显著危险因素。
接受OPCAB且采用完全动脉移植血管的老年患者在5年以上未显示出生存获益或无MACCE获益。
