title: The impact of incomplete revascularization and angiographic patency on midterm results after off-pump coronary artery bypass grafting.
abstract: OBJECTIVE
  Higher rates of incomplete revascularization (IR) and reduced patency are possible drawbacks of off-pump coronary artery bypass grafting (OPCAB); both may adversely affect outcome after surgery. This study was conducted to shed light on the relationships among IR, angiographic patency, and midterm results after OPCAB surgery.
  
  
  METHODS
  A total of 1604 consecutive patients underwent OPCAB during a 6-year period; 1581 patients (95%) underwent systematic postoperative angiography. Complete follow-up was achieved in 99.5% (median, 3.2 years; up to 6.5 years). A total of 216 patients had IR (13%), and 225 had at least 1 graft failure (FitzGibbon B or O).
  
  
  RESULTS
  All the event-free survival rates for all-cause mortality (P < .001), cardiac death (P = .020), and major adverse cardiac and cerebrovascular events (P < .001) were lower in the IR group. By using the Cox proportional hazards model, IR was an independent risk factor for all-cause mortality (hazard ratio [HR], 1.80; 95% confidence interval [CI], 1.15-2.81). Of those who underwent postoperative angiography, the patients with graft failure experienced reintervention more frequently than those with all grafts patent (HR, 5.49; 95% CI, 3.43-8.77). Even with excluding patients who had undergone reintervention immediately after angiography, graft failure was still an independent risk factor for reintervention afterwards (HR, 2.41; 95% CI, 1.30-4.47).
  
  
  CONCLUSIONS
  Incomplete revascularization was relevant to higher midterm mortality after OPCAB, whereas the risk of reintervention was higher for patients with occluded grafts. Complete revascularization, coupled with achievement of a higher patency rate, could be expected to improve follow-up outcomes after OPCAB surgery.
authors.affiliation: Department of Cardiovascular Surgery, Kokura Memorial Hospital, Fukuoka; Kyoto, Japan; Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: jotanakano@gmail.com.
authors.forename: Jota
authors.initials: J
authors.lastname: Nakano
authors.affiliation: Department of Cardiovascular Surgery, Kokura Memorial Hospital, Fukuoka; Kyoto, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Memorial Heart Center, Iwate; Kyoto, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Okabayashi
authors.affiliation: Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Noma
authors.affiliation: Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan.
authors.forename: Tosiya
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Sakata
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency