Multiarterial grafts improve the rate of early major adverse cardiac and cerebrovascular events in patients undergoing coronary revascularization: Analysis of 12 615 patients with multivessel disease

Chaim Locker, Hartzell V Schaff, Richard C.Daly, Malcolm R. Bell, Robert L. Frye, John M. Stulak, Sameh M. Said, Joseph A. Dearani, Lyle D. Joyce, Kevin L. Greason, Alberto Pochettino, Zhuo Li, Ryan J. Lennon, Amir Lerman

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

OBJECTIVES: Our goal was to compare the rates of in-hospital and 30-day major adverse cardiac and cerebrovascular events (MACCE) including death, stroke, myocardial infarction and repeat revascularization in patients with multivessel disease undergoing multiarterial (MultArt) coronary artery bypass grafting (CABG) with the left internal mammary artery/saphenous vein (LIMA/SV) CABG or percutaneous coronary intervention (PCI). METHODS: From 1 January 1993 to 31 December 2009, 12 615 consecutive patients underwent isolated primary CABG (n = 6667) with LIMA/SV (n = 5712) or MultArt (n = 955) or were treated by PCI (n = 5948) with balloon angioplasty (n = 1020), bare metal stent (n = 3242), and drug-eluting stent (n = 1686). We excluded patients with acute myocardial infarction. We matched the CABG group with the 3 PCI subgroups, and the PCI group with the 2 CABG subgroups. Multivariable analyses were used to evaluate the impact of CABG versus PCI and their subgroups on early MACCE. RESULTS: Unadjusted early MACCE were lower for MultArt (1.5%) than for LIMA/SV (4.5%, P < 0.001) and PCI (8.5%, P < 0.001). In matched analysis, CABG had lower early MACCE versus balloon angioplasty (4.7% vs 13.2%, P < 0.001), bare metal stent (4.3% vs 8.3%, P < 0.001), and drug-eluting stent (2.9% vs 5.5%, P = 0.008), as well as LIMA/SV versus PCI (4.6% vs 9.2%, P < 0.001) and MultArt versus PCI (1.8% vs 7.8%, P < 0.001). Stroke rate was similar in MultArt versus PCI (0.8% vs 0.3%, P = 0.18) but higher with LIMA/SV versus PCI (2.3% vs 0.4%, P < 0.001). In multivariable analysis, PCI (odds ratio 4.53, 95% confidence interval: 2.62-7.83; P < 0.001) and LIMA/SV (odds ratio 2.04, 95% confidence interval: 1.18-3.53; P < 0.011) were strong predictors of early MACCE compared with MultArt. CONCLUSIONS: MultArt confers the lowest rate of early MACCE.

Original languageEnglish (US)
Pages (from-to)746-752
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume52
Issue number4
DOIs
StatePublished - Oct 1 2017

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Percutaneous Coronary Intervention
Transplants
Mammary Arteries
Coronary Artery Bypass
Saphenous Vein
Drug-Eluting Stents
Balloon Angioplasty
Stents
Metals
Stroke
Odds Ratio
Myocardial Infarction
Confidence Intervals

Keywords

  • Bypass grafting
  • Coronary disease
  • MACCE
  • Stents

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Multiarterial grafts improve the rate of early major adverse cardiac and cerebrovascular events in patients undergoing coronary revascularization : Analysis of 12 615 patients with multivessel disease. / Locker, Chaim; Schaff, Hartzell V; C.Daly, Richard; Bell, Malcolm R.; Frye, Robert L.; Stulak, John M.; Said, Sameh M.; Dearani, Joseph A.; Joyce, Lyle D.; Greason, Kevin L.; Pochettino, Alberto; Li, Zhuo; Lennon, Ryan J.; Lerman, Amir.

In: European Journal of Cardio-thoracic Surgery, Vol. 52, No. 4, 01.10.2017, p. 746-752.

Research output: Contribution to journalArticle

Locker, Chaim ; Schaff, Hartzell V ; C.Daly, Richard ; Bell, Malcolm R. ; Frye, Robert L. ; Stulak, John M. ; Said, Sameh M. ; Dearani, Joseph A. ; Joyce, Lyle D. ; Greason, Kevin L. ; Pochettino, Alberto ; Li, Zhuo ; Lennon, Ryan J. ; Lerman, Amir. / Multiarterial grafts improve the rate of early major adverse cardiac and cerebrovascular events in patients undergoing coronary revascularization : Analysis of 12 615 patients with multivessel disease. In: European Journal of Cardio-thoracic Surgery. 2017 ; Vol. 52, No. 4. pp. 746-752.
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abstract = "OBJECTIVES: Our goal was to compare the rates of in-hospital and 30-day major adverse cardiac and cerebrovascular events (MACCE) including death, stroke, myocardial infarction and repeat revascularization in patients with multivessel disease undergoing multiarterial (MultArt) coronary artery bypass grafting (CABG) with the left internal mammary artery/saphenous vein (LIMA/SV) CABG or percutaneous coronary intervention (PCI). METHODS: From 1 January 1993 to 31 December 2009, 12 615 consecutive patients underwent isolated primary CABG (n = 6667) with LIMA/SV (n = 5712) or MultArt (n = 955) or were treated by PCI (n = 5948) with balloon angioplasty (n = 1020), bare metal stent (n = 3242), and drug-eluting stent (n = 1686). We excluded patients with acute myocardial infarction. We matched the CABG group with the 3 PCI subgroups, and the PCI group with the 2 CABG subgroups. Multivariable analyses were used to evaluate the impact of CABG versus PCI and their subgroups on early MACCE. RESULTS: Unadjusted early MACCE were lower for MultArt (1.5{\%}) than for LIMA/SV (4.5{\%}, P < 0.001) and PCI (8.5{\%}, P < 0.001). In matched analysis, CABG had lower early MACCE versus balloon angioplasty (4.7{\%} vs 13.2{\%}, P < 0.001), bare metal stent (4.3{\%} vs 8.3{\%}, P < 0.001), and drug-eluting stent (2.9{\%} vs 5.5{\%}, P = 0.008), as well as LIMA/SV versus PCI (4.6{\%} vs 9.2{\%}, P < 0.001) and MultArt versus PCI (1.8{\%} vs 7.8{\%}, P < 0.001). Stroke rate was similar in MultArt versus PCI (0.8{\%} vs 0.3{\%}, P = 0.18) but higher with LIMA/SV versus PCI (2.3{\%} vs 0.4{\%}, P < 0.001). In multivariable analysis, PCI (odds ratio 4.53, 95{\%} confidence interval: 2.62-7.83; P < 0.001) and LIMA/SV (odds ratio 2.04, 95{\%} confidence interval: 1.18-3.53; P < 0.011) were strong predictors of early MACCE compared with MultArt. CONCLUSIONS: MultArt confers the lowest rate of early MACCE.",
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TY - JOUR

T1 - Multiarterial grafts improve the rate of early major adverse cardiac and cerebrovascular events in patients undergoing coronary revascularization

T2 - Analysis of 12 615 patients with multivessel disease

AU - Locker, Chaim

AU - Schaff, Hartzell V

AU - C.Daly, Richard

AU - Bell, Malcolm R.

AU - Frye, Robert L.

AU - Stulak, John M.

AU - Said, Sameh M.

AU - Dearani, Joseph A.

AU - Joyce, Lyle D.

AU - Greason, Kevin L.

AU - Pochettino, Alberto

AU - Li, Zhuo

AU - Lennon, Ryan J.

AU - Lerman, Amir

PY - 2017/10/1

Y1 - 2017/10/1

N2 - OBJECTIVES: Our goal was to compare the rates of in-hospital and 30-day major adverse cardiac and cerebrovascular events (MACCE) including death, stroke, myocardial infarction and repeat revascularization in patients with multivessel disease undergoing multiarterial (MultArt) coronary artery bypass grafting (CABG) with the left internal mammary artery/saphenous vein (LIMA/SV) CABG or percutaneous coronary intervention (PCI). METHODS: From 1 January 1993 to 31 December 2009, 12 615 consecutive patients underwent isolated primary CABG (n = 6667) with LIMA/SV (n = 5712) or MultArt (n = 955) or were treated by PCI (n = 5948) with balloon angioplasty (n = 1020), bare metal stent (n = 3242), and drug-eluting stent (n = 1686). We excluded patients with acute myocardial infarction. We matched the CABG group with the 3 PCI subgroups, and the PCI group with the 2 CABG subgroups. Multivariable analyses were used to evaluate the impact of CABG versus PCI and their subgroups on early MACCE. RESULTS: Unadjusted early MACCE were lower for MultArt (1.5%) than for LIMA/SV (4.5%, P < 0.001) and PCI (8.5%, P < 0.001). In matched analysis, CABG had lower early MACCE versus balloon angioplasty (4.7% vs 13.2%, P < 0.001), bare metal stent (4.3% vs 8.3%, P < 0.001), and drug-eluting stent (2.9% vs 5.5%, P = 0.008), as well as LIMA/SV versus PCI (4.6% vs 9.2%, P < 0.001) and MultArt versus PCI (1.8% vs 7.8%, P < 0.001). Stroke rate was similar in MultArt versus PCI (0.8% vs 0.3%, P = 0.18) but higher with LIMA/SV versus PCI (2.3% vs 0.4%, P < 0.001). In multivariable analysis, PCI (odds ratio 4.53, 95% confidence interval: 2.62-7.83; P < 0.001) and LIMA/SV (odds ratio 2.04, 95% confidence interval: 1.18-3.53; P < 0.011) were strong predictors of early MACCE compared with MultArt. CONCLUSIONS: MultArt confers the lowest rate of early MACCE.

AB - OBJECTIVES: Our goal was to compare the rates of in-hospital and 30-day major adverse cardiac and cerebrovascular events (MACCE) including death, stroke, myocardial infarction and repeat revascularization in patients with multivessel disease undergoing multiarterial (MultArt) coronary artery bypass grafting (CABG) with the left internal mammary artery/saphenous vein (LIMA/SV) CABG or percutaneous coronary intervention (PCI). METHODS: From 1 January 1993 to 31 December 2009, 12 615 consecutive patients underwent isolated primary CABG (n = 6667) with LIMA/SV (n = 5712) or MultArt (n = 955) or were treated by PCI (n = 5948) with balloon angioplasty (n = 1020), bare metal stent (n = 3242), and drug-eluting stent (n = 1686). We excluded patients with acute myocardial infarction. We matched the CABG group with the 3 PCI subgroups, and the PCI group with the 2 CABG subgroups. Multivariable analyses were used to evaluate the impact of CABG versus PCI and their subgroups on early MACCE. RESULTS: Unadjusted early MACCE were lower for MultArt (1.5%) than for LIMA/SV (4.5%, P < 0.001) and PCI (8.5%, P < 0.001). In matched analysis, CABG had lower early MACCE versus balloon angioplasty (4.7% vs 13.2%, P < 0.001), bare metal stent (4.3% vs 8.3%, P < 0.001), and drug-eluting stent (2.9% vs 5.5%, P = 0.008), as well as LIMA/SV versus PCI (4.6% vs 9.2%, P < 0.001) and MultArt versus PCI (1.8% vs 7.8%, P < 0.001). Stroke rate was similar in MultArt versus PCI (0.8% vs 0.3%, P = 0.18) but higher with LIMA/SV versus PCI (2.3% vs 0.4%, P < 0.001). In multivariable analysis, PCI (odds ratio 4.53, 95% confidence interval: 2.62-7.83; P < 0.001) and LIMA/SV (odds ratio 2.04, 95% confidence interval: 1.18-3.53; P < 0.011) were strong predictors of early MACCE compared with MultArt. CONCLUSIONS: MultArt confers the lowest rate of early MACCE.

KW - Bypass grafting

KW - Coronary disease

KW - MACCE

KW - Stents

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