title: Myocardial revascularization with and without cardiopulmonary bypass in multivessel disease: impact of strategy on midterm outcome.
abstract: BACKGROUND
  In a previous study, we demonstrated that patients with multivessel disease benefit during the first postoperative month from elimination of cardiopulmonary bypass (CPB). We evaluated the midterm results of the same patients excluding the first postoperative month from the analysis.
  
  
  METHODS
  From May 1997 to November 2000, 1,802 patients with multivessel disease survived the first postoperative month; 906 were operated on without (group A) and 896 with (group B) CPB. Follow-up ranged from 23 to 65 months (mean, 42 +/- 12 months). Four-year actuarial freedom from the following events was evaluated: death from any cause; cardiac death; acute myocardial infarction (AMI) in any territory; AMI in a grafted area; redo percutaneous transluminal coronary angioplasty (PTCA); redo PTCA in a target vessel; cardiac events (death from a cardiac cause, acute myocardial infarction on grafted vessel, redo PTCA on target vessel); and any event.
  
  
  RESULTS
  No statistical difference was found between groups A and B with regard to freedom from any death (95.3 +/- 0.8 vs 95.7 +/- 0.7, p = 0.5160); from cardiac death (97.3 +/- 0.6 vs 97.5 +/- 0.6, p = 0.5345); from AMI (98.4 +/- 0.4 vs 98.7 +/- 0.4, p = 0.4655); from AMI in a grafted area (98.9 +/- 0.4 vs 98.7 +/- 0.4, p = 0.9374); from redo PTCA (97.9 +/- 0.5 vs 97.7 +/- 0.6, p = 0.8485); from redo PTCA in a grafted area (98.7 +/- 0.4 vs 98.5 +/- 0.5, p = 0.8774); from target cardiac events (95.8 +/- 0.7 vs 95.9 +/- 0.8, p = 0.6070); and from any event (92.9 +/- 0.9 vs 93.4 +/- 1.0, p = 0.3721).
  
  
  CONCLUSIONS
  After exclusion of the first postoperative month, myocardial revascularization without CPB has midterm results similar to myocardial revascularization with CPB. In particular, failure of revascularization does not depend on intraoperative strategy.
authors.affiliation: Department of Cardiology and Cardiac Surgery, University "G. D'Annunzio,", Chieti, Italy. calafiore@unich.it
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Calafiore
authors.forename: Michele
authors.initials: M
authors.lastname: Di Mauro
authors.forename: Carlo
authors.initials: C
authors.lastname: Canosa
authors.forename: Sergio
authors.initials: S
authors.lastname: Cirmeni
authors.forename: Angela Lorena
authors.initials: AL
authors.lastname: Iacò
authors.forename: Marco
authors.initials: M
authors.lastname: Contini
authors.forename: Valerio
authors.initials: V
authors.lastname: Mazzei
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000379:methods / Q000401:mortality; D016022:Case-Control Studies; D015331:Cohort Studies; D016001:Confidence Intervals; D003327:Coronary Disease / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods* / Q000401:mortality*; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome