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Effect of revascularization on coronary chronic total occlusion in patients undergoing coronary artery bypass grafting

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Affiliated Author(s)
김윤석
Alternative Author(s)
Kim, Yun Seok
Journal Title
J Thorac Dis
ISSN
2077-6624
Issued Date
2021
Keyword
Coronary artery bypass grafting (CABG)chronic total occlusion of coronary artery (CTO of coronary artery)complete revascularization
Abstract
Background:
Bypass grafting for chronic total occlusions (CTOs) remains surgically challenging and controversial. Therefore, we evaluated the incidence and clinical outcomes of revascularization on CTOs undergoing coronary artery bypass grafting (CABG).

Methods:
Among 828 patients who underwent isolated CABG from January 2010 to December 2018, 245 patients (29.6%) diagnosed with at least one CTO were included and retrospectively reviewed. Primary endpoints were 30-day and overall mortality. Secondary endpoint was the composite outcome of major adverse cardiac and cerebrovascular events (MACCE).

Results:
With a mean follow-up of 56.6±6.5 months in 245 patients with CTOs, 51 patients (20.8%) received incomplete revascularization (ICR) for CTO lesions. Risk factor analysis showed that ICR was associated with increased 30-day [odds ratio 8.62; 95% confidence interval (CI): 1.64–50; P=0.011] and overall mortality (hazard ratio (HR) 2.13; 95% CI: 1.07–4.21; P=0.03). ICR also increased the risk of MACCE (HR 1.98; 95% CI: 1.12–3.54; P=0.01). Freedom from overall mortality was 92.8%, 90.4%, and 86.8% in the complete revascularization group, and 86.3%, 80.0%, and 72.7% in the ICR group, at 1, 3, and 5 years, respectively (P=0.004).

Conclusions:
In patients with CTOs undergoing CABG, the rate of ICR was 20.8%, and it significantly increased the risk of mortality and MACCE. Further studies in a large cohort are needed.
Department
Dept. of Thoracic & Cardiovascular Surgery (흉부외과학)
Publisher
School of Medicine (의과대학)
Citation
Jiyun Lee1 et al. (2021). Effect of revascularization on coronary chronic total occlusion in patients undergoing coronary artery bypass grafting. J Thorac Dis, 13(11), 6343–6352. doi: 10.21037/jtd-21-681
Type
Article
ISSN
2077-6624
DOI
10.21037/jtd-21-681
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/44135
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Thoracic & Cardiovascular Surgery (흉부외과학)
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