Higher Cardiac Mortality and Myocardial Infarction Rates with Venous Compared to Arterial Revascularization of the Right Coronary Artery in BIMA Coronary Surgery: A 20-Year Propensity-Score–Matched Follow-up Study

Background: To compare the results of venous versus arterial revascularization of the right coronary (RCA) territory in patients undergoing coronary bypass surgery with bilateral mammary revascularization.

Method: In this retrospective, propensity-score matched, case-control, cross-sectional study, all patients with three-vessel coronary disease who underwent coronary revascularization from January 1999 to December 2000 were screened for inclusion. The inclusion criteria included all patients who underwent surgery using bilateral mammary arteries (BIMA). The exclusion criteria comprised reoperations, missing perioperative data, and loss to follow-up. The included patients were divided into two groups: Group 1 underwent complete arterial revascularization with BIMA to all three coronary territories and group 2 underwent a BIMA revascularization to the left coronary system and a separate venous revascularization to the RCA territory. Both groups were then propensity-score matched according to age, sex, diabetes status, smoking, renal impairment, arterial hypertension, ejection fraction, hyperlipidemia, peripheral vascular disease, NYHA class, and BMI. The primary endpoint was all-cause mortality. The secondary endpoints were death due to cardiac cause, myocardial infarction, stroke, reintervention, and RCA bypass patency in follow-up coronary catheterization.

Results: A total of 883 patients were screened; 452 met the primary inclusion criteria. Twenty-year follow-up data were available for 318 patients (70.4%). After 1:1 matching, 274 patients were matched and included in the study (137 for each group). There were no perioperative significant differences between the groups. Kaplan–Meier curves showed no significant differences between group 1 and 2 on overall 20-year survival (49 vs. 40%, p = 0.145). Group 2 had a higher cardiac mortality (41 vs. 22%, p =0.021) and myocardial infarction rates (21 vs. 12%, p = 0.04). There were no significant differences between the groups regarding the other secondary endpoints. 55% of group 1 and 67% of group 2 underwent coronary angiogram during follow-up. The coronary angiogram showed a higher right coronary bypass patency in group 1 but with no statistical significance (77 vs. 57%, p = 0.0338).

Conclusion: Arterial revascularization of the right coronary system in BIMA coronary surgery shows lower infarction rates and cardiac deaths after 20 years of follow-up. Complete arterial revascularization should be encouraged for all coronary territories.

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Artikel online veröffentlicht:
28. Januar 2023