title: Does the complexity of coronary artery disease affect outcomes after complete revascularization with long segmental reconstruction of the left anterior descending artery using the left internal thoracic artery?
abstract: OBJECTIVE
  We evaluated the influence of the complexity of coronary artery disease stratified by the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score on early or late outcomes after complete revascularization with long segmental reconstruction of the left anterior descending artery using the left internal thoracic artery.
  
  
  METHODS
  From March 1995 to December 2003, a total of 102 patients with triple-vessel and/or left main disease underwent complete revascularization with long segmental left anterior descending artery reconstruction (≥2 cm) with or without endarterectomy using the left internal thoracic artery. The patients were divided into two groups according to the median SYNTAX score: the low group (SYNTAX score of <32, n = 50) and the high group (SYNTAX score of ≥32, n = 52). Outcomes were compared between the two groups, and predictors of follow-up death and major adverse cardiac and cerebrovascular events were determined.
  
  
  RESULTS
  The mean number of distal anastomoses was 4.2 ± 1.1, and complete revascularization was achieved in 96% of patients. The early mortality rate was 2.9%, and no significant differences in the perioperative results were observed between groups. There were no significant differences in overall survival or major adverse cardiac and cerebrovascular event-free survival between the two groups. The hazard ratio of SYNTAX score for early mortality was 0.94 (95% confidence interval: 0.88-1.01) and for major adverse cardiac and cerebrovascular events was 0.97 (95% confidence interval: 0.92-1.02).
  
  
  CONCLUSIONS
  The complexity of coronary artery disease had no impact on early or late outcomes after complete revascularization with long segmental left anterior descending artery reconstruction using the left internal thoracic artery.
authors.affiliation: Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan kato20001224@gmail.com.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kato
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takanashi
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fukui
authors.affiliation: Department of Cardiology, Osaka City General Hospital, Osaka, Japan.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Naruko
authors.affiliation: Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Shibata
authors.affiliation: Department of Cardiovascular Surgery, Ishikiriseiki Hospital, Osaka, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Complete revascularization; Complex coronary artery disease; Coronary artery bypass