title: Incomplete revascularization reduces survival benefit of coronary artery bypass grafting: role of off-pump surgery.
abstract: OBJECTIVE
  We sought to analyze the influence, if any, of incomplete revascularization and on/off-pump techniques on long-term mortality after coronary artery bypass grafting.
  
  
  METHODS
  A total of 9408 patients undergoing coronary artery bypass grafting, 8461 on pump and 947 off pump, operated on between 1995 and 2004 were included in the study. Adjusted hazard function for long-term mortality was estimated with Poisson regression analysis in a model that included variables reflecting completeness of revascularization, operative method (on/off pump), and background risk factors for death.
  
  
  RESULTS
  Mean follow-up after surgical intervention for survivors was 5.0 +/- 2.8 years (range, 0.5-10.5 years), with a total follow-up of 45,076 patient years. Leaving 1 diseased vascular segment without a bypass graft in 2- or 3-vessel disease did not increase the hazard ratio for death in comparison with complete revascularization (hazard ratio, 1.05; 95% confidence interval, 0.87-1.27; P = .60). In contrast, leaving 2 vascular segments without a bypass graft in 3-vessel disease was associated with an increased hazard ratio for death (hazard ratio, 1.82; 95% confidence interval, 1.15-2.85; P = .01). Incomplete revascularization was more common in the off-pump group (P < .001) in our study. If adjusting for incomplete revascularization, there was no significant influence of the use of on/off-pump techniques on the hazard ratio for death (hazard ratio, 1.08; 95% confidence interval, 0.82-1.40; P = .57).
  
  
  CONCLUSIONS
  Incomplete revascularization of patients with 3-vessel disease is an independent risk factor for increased long-term mortality after coronary artery bypass grafting. In contrast, the use of on- or off-pump techniques had no significant effect on survival after adjusting for incomplete revascularization.
authors.affiliation: Department of Molecular and Clinical Medicine/Cardiothoracic Surgery, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden. mats.synnergren@vgregion.se
authors.forename: Mats J
authors.initials: MJ
authors.lastname: Synnergren
authors.forename: Rolf
authors.initials: R
authors.lastname: Ekroth
authors.forename: Anders
authors.initials: A
authors.lastname: Odén
authors.forename: Helena
authors.initials: H
authors.lastname: Rexius
authors.forename: Lars
authors.initials: L
authors.lastname: Wiklund
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000453:epidemiology; D015906:Angioplasty, Balloon, Coronary; D015984:Causality; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality*; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods / Q000401:mortality; D023921:Coronary Stenosis / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D009204:Myocardial Revascularization / Q000009:adverse effects* / Q000379:methods*; D016016:Proportional Hazards Models; D012086:Reoperation; D018570:Risk Assessment; D015996:Survival Rate