Long-term Outcomes of Coronary Artery Bypass Grafting in Veterans with Left Main Coronary Artery Disease

Authors

  • Sheena W. Chen, MD Division of Cardiothoracic Surgery and Heart Center, Washington D.C. Veterans Affairs Medical Center, Washington, D.C., USA
  • Ethan Rosenfeld, M Division of Cardiothoracic Surgery and Heart Center, Washington D.C. Veterans Affairs Medical Center, Washington, D.C., USA
  • K. Benjamin Lee, MD Department of Surgery, George Washington University, Washington, D.C., USA
  • Michael Napolitano, MD Division of Cardiothoracic Surgery and Heart Center, Washington D.C. Veterans Affairs Medical Center, Washington, D.C., USA
  • Andrew D. Sparks, MS Department of Surgery, George Washington University, Washington, D.C., USA
  • Jeffrey Panting-Crespo, MD Division of Cardiothoracic Surgery and Heart Center, Washington D.C. Veterans Affairs Medical Center, Washington, D.C., USA
  • Gregory D. Trachiotis, MD Division of Cardiothoracic Surgery and Heart Center, Washington D.C. Veterans Affairs Medical Center, Washington, D.C., USA

DOI:

https://doi.org/10.1532/hsf.3081

Keywords:

Left main coronary artery disease, Coronary artery bypass graft (CABG), Off pump CABG , On pump CABG , Veterans Affairs

Abstract

Background: Studies of the civilian population with left main coronary artery disease (LMCAD) who underwent coronary artery bypass grafting (CABG) have shown 2% to 4.2% 30-day mortality. However, there is a lack of reporting from the veteran population. Here we analyze the outcomes of veterans with LMCAD who underwent CABG by a single surgeon at a single Veterans Affairs Medical Center (VAMC).

Methods: Veterans who underwent isolated CABG between 1998 to 2018 at a VAMC were further divided into a group with significant left main coronary artery disease (LMCAD) of stenosis greater than or equal to 50% and a group without left main coronary artery stenosis (non-LMCAD). The primary outcome was mortality.
Secondary outcomes included postoperative complications. Multivariable regression analysis and Kaplan-Meier survival analysis were used to compare the two cohorts.

Results: The demographics and comorbidities are similar between the two cohorts except for higher average age and percentage of stroke in the LMCAD group (n = 509) compared to non-LMCAD (n = 927). Perioperative complications are comparable between the two groups except for increased length of stay (LOS) in the LMCAD group (12.9 ± 15.9 days versus 10.9 ± 9.0 days in non-LMCAD, P < .001). 30-day mortality in the LMCAD group is 4.1% versus 1.4% in non-LMCAD. However, Kaplan-Meier curves show no significant difference in adjusted overall survival throughout 15 years between the groups (P = .560).

Conclusion: Veterans with LMCAD who underwent CABG have similar postoperative complications compared to non-LMCAD group. The 30-day mortality is higher in the LMCAD group; however, there is no difference in long-term survival.

References

Alexander JH, Smith PK. 2016. Coronary-artery bypass grafting. N Engl J Med 374:1954-64.

Authors/Task Force members, Windecker S, Kolh P, et al. 2014. ESC/EACTS guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Euro Heart J 35:2541-619.

Buszman PE, Buszman PP, Banasiewicz-Szkróbka I, et al. 2016. Left main stenting in comparison with surgical revascularization: 10-year outcomes of the (Left Main Coronary Artery Stenting) LE MANS trial. JACC: Cardiovasc Interv 9:318-27.

Cho SC, Park DW, Park SJ. 2019. Percutaneous coronary intervention and coronary artery bypass grafting for the treatment of left main coronary artery disease. Korean Circ J 49:369-83.

Deppe AC, Weber C, Liakopoulos OJ, et al. 2017. Preoperative intra‐aortic balloon pump use in high‐risk patients prior to coronary artery bypass graft surgery decreases the risk for morbidity and mortality—A meta-analysis of 9,212 patients. J Card Surg 32:177-85.

Fihn SD, Blankenship JC, Alexander KP, et al. 2014. ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 64:1929-49.

Harskamp RE, Vassiliades TA, Mehta RH, et al. 2015. Comparative effectiveness of hybrid coronary revascularization vs coronary artery bypass grafting. J Am Coll Surg 221:326-34.

Head SJ, Milojevic M, Daemen J, et al. 2018. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet 391:939-48.

Lee PH, Ahn JM, Chang M, et al. 2016. Left main coronary artery disease: secular trends in patient characteristics, treatments, and outcomes. J Am Coll Surg 68:1233-46.

Modolo R, Chichareon P, Kogame N, et al. 2019. Contemporary Outcomes Following Coronary Artery Bypass Graft Surgery for Left Main Disease. J Am Coll Surg 73:1877-86.

Morice MC, Serruys PW, Kappetein AP, et al. 2010. Outcomes in Patients With De Novo Left Main Disease Treated With Either Percutaneous Coronary Intervention Using Paclitaxel-Eluting Stents or Coronary Artery Bypass Graft Treatment in the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) Trial. Circulation 121:2645-53.

Morice MC, Serruys PW, Kappetein AP, et al. 2014. Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with TAXUS and cardiac surgery trial. Circulation 129:2388-94.

Nerlekar N, Ha FJ, Verma KP, et al. 2016. Percutaneous coronary intervention using drug-eluting stents versus coronary artery bypass grafting for unprotected left main coronary artery stenosis: a meta-analysis of randomized trials. Circ Cardiovasc Interv 9:e004729.

Ramadan R, Boden WE, Kinlay S. 2018. Management of left main coronary artery disease. J Am Heart Association 7:e008151.

Scherer LD, Fagerlin A. 2019. Shared Decision-Making in Revascularization Decisions: Complexities and Challenges. Circulation: Cardiovasc Qual Outcomes

Shroyer AL, Hattler B, Wagner TH, et al. 2017. Five-year outcomes after on-pump and off-pump coronary-artery bypass. N Engl J Med 377:623-32.

Stone GW, Sabik JF, Serruys PW, et al. 2016. Everolimus-eluting stents or bypass surgery for left main coronary artery disease. N Engl J Med 375:2223-2235.

Takaro T, Peduzzi P, Detre KM, et al. 1982. Survival in subgroups of patients with left main coronary artery disease. Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease. Circulation 66:14-22.

Taggart DP, Kaul S, Boden WE, et al. 2008. Revascularization for unprotected left main stem coronary artery stenosis: stenting or surgery. J Am Coll Cardiol 51:885-92.

VA Coronary Artery Bypass Surgery Cooperative Study Group. 1992. Eighteen-year follow-up in the Veterans Affairs Cooperative Study of Coronary Artery Bypass Surgery for stable angina. Circulation 86:121.

Vaughan-Sarrazin MS, Wakefield B, Rosenthal GE. 2007. Mortality of Department of Veterans Affairs patients undergoing coronary revascularization in private sector hospitals. Health Services Research 42:1802-21.

Published

2020-07-24

How to Cite

Chen, S., Rosenfeld, E. ., Lee, K. B., Napolitano, M. ., Sparks, A. D., Panting-Crespo, J. ., & Trachiotis, G. D. (2020). Long-term Outcomes of Coronary Artery Bypass Grafting in Veterans with Left Main Coronary Artery Disease. The Heart Surgery Forum, 23(4), E531-E536. https://doi.org/10.1532/hsf.3081

Issue

Section

Article