title: In the current era, complete revascularization improves survival after coronary artery bypass surgery.
abstract: BACKGROUND
  Complete revascularization has been the standard for coronary bypass grafting. However, surgical intervention has evolved with increasing use of arterial conduits and off-pump techniques.
  
  
  METHODS
  Patients undergoing non-redo bypass surgery from January 1998 through December 2000 were followed up with questionnaires and telephone contact. Incomplete revascularization was defined as absence of bypass grafts placed to a coronary territory supplied by a vessel with 50% or greater stenosis.
  
  
  RESULTS
  One thousand thirty-four patients were followed for a mean of 3.3 +/- 1.6 years. Complete revascularization was found in 937 (90.6%) patients, and incomplete revascularization was found in 97 (9.4%) patients. Eight hundred twenty-seven (80.4%) patients underwent on-pump operations, and 207 (19.6%) underwent off-pump operations. Incomplete revascularization was more prevalent in off-pump versus on-pump operations (21.7% vs 6.3%, P < .001). Multivariable Cox regression analysis indicated that in-hospital cerebrovascular accidents (hazard ratio, 5.49; P < .001), chronic obstructive pulmonary disease (hazard ratio, 1.97; P = .019), and incomplete revascularization (hazard ratio, 1.85; P = .040) predicted an increased hazard (risk) of cardiac death. Left internal thoracic artery (hazard ratio, 0.38; P = .047), right internal thoracic artery (hazard ratio, 0.25; P = .019), and radial artery (hazard ratio, 0.36; P < .001) grafting reduced the risk of cardiac death. The 5-year unadjusted survival rate was 52.6% versus 82.4% in patients undergoing incomplete and complete revascularization ( P < .001), with cardiac survival rates of 74.5% versus 93.1%, respectively ( P < .001). However, this difference in cardiac survival was smaller in octogenarians with incomplete versus complete revascularizations (77.4% vs 87.6%, P = .101) and was essentially absent in off-pump versus on-pump operations if complete revascularization was achieved in both cases (93.6% vs 93.1%, P > .200).
  
  
  CONCLUSIONS
  Complete revascularization and arterial grafting improve 5-year survival. Off-pump techniques do not affect survival. Complete revascularization should be performed whenever possible.
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kleisli
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.forename: Milagros J
authors.initials: MJ
authors.lastname: Jacobs
authors.forename: James
authors.initials: J
authors.lastname: Mirocha
authors.forename: Michele A
authors.initials: MA
authors.lastname: Derobertis
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kass
authors.forename: Carlos
authors.initials: C
authors.lastname: Blanche
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Fontana
authors.forename: Sharo S
authors.initials: SS
authors.lastname: Raissi
authors.forename: Kathy E
authors.initials: KE
authors.lastname: Magliato
authors.forename: Alfredo
authors.initials: A
authors.lastname: Trento
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000379:methods* / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D012044:Regression Analysis; D015996:Survival Rate; D013997:Time Factors