Key result
Total arterial revascularization was associated with a nearly 30% improvement in late survival compared to non-total arterial revascularization in patients with preoperative atrial fibrillation (HR 0.72).
Why the study?
Preoperative AF is common and associated with poorer prognosis in patients referred for CABG, but the influence of surgical revascularization technique on survival in this group is unknown.
Does total arterial revascularization improve long-term survival in patients with preoperative atrial fibrillation undergoing CABG for multivessel coronary artery disease?
Cohort (n=590)
Yes
Does total arterial revascularization improve long-term survival in patients with preoperative atrial fibrillation undergoing CABG for multivessel coronary artery disease?
Total arterial revascularization during CABG in patients with preoperative atrial fibrillation is associated with significantly improved long-term survival compared to using venous grafts, without increasing perioperative risk.
BACKGROUND: Atrial fibrillation (AF) is a relatively common comorbidity among patients referred for coronary artery bypass grafting (CABG) and is associated with poorer prognosis. However, little is known about how surgical technique influences survival in this population. AIM: The current analysis aimed to determine whether total arterial revascularization (TAR) is associated with improved long-term outcomes in patients with preoperative AF. METHODS: We analyzed patients' data from the HEIST (HEart surgery In atrial fibrillation and Supraventricular Tachycardia) registry. The registry, to date, involves five tertiary high-volume centers in Poland. Between 2006 and 2019, 4746 patients presented with preoperative AF and multivessel coronary artery disease and underwent CABG. We identified cases of TAR and used propensity score matching to determine non-TAR controls. Median follow-up was 4.1 years (interquartile range [IQR], 1.9-6.8 years). RESULTS: Propensity matching resulted in 295 pairs of TAR vs. non-TAR. The mean (standard deviation [SD]) number of distal anastomoses was 2.5 (0.6) vs. 2.5 (0.6) (P = 0.94) respectively. Operative and 30-day mortality was not different between TAR and non-TAR patients (hazard ratio [HR] and 95% confidence intervals [CIs], 0.17 (0.02-1.38); P = 0.12 and 0.74 [0.40-1.35]; P = 0.33, respectively). By contrast, TAR was associated with nearly 30% improved late survival: HR, 0.72 (0.55-0.93); P = 0.01. This benefit was sustained in subgroup analyses, yet most pronounced in low-risk patients ( < 70 years old; EuroSCORE II < 2; no diabetes) and when off-pump CABG was performed. CONCLUSIONS: TAR in patients with preoperative AF is safe and associated with improved survival, with particular survival benefits in younger low-risk patients undergoing off-pump CABG.
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Pasierski et al. (2022) conducted a cohort in Preoperative atrial fibrillation and multivessel coronary artery disease (n=590). Total arterial revascularization vs. Non-total arterial revascularization was evaluated on Long-term mortality (HR 0.72, 95% CI 0.55-0.93, p=0.01). Total arterial revascularization was associated with a nearly 30% improvement in late survival compared to non-total arterial revascularization in patients with preoperative atrial fibrillation (HR 0.72).
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