{"id":2991,"date":"2020-02-19T00:00:00","date_gmt":"2020-02-19T05:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/long-term-outcomes-associated-with-total-arterial-revascularization-vs-non-total-arterial-revascularization\/"},"modified":"2023-06-14T20:00:29","modified_gmt":"2023-06-15T00:00:29","slug":"long-term-outcomes-associated-with-total-arterial-revascularization-vs-non-total-arterial-revascularization","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/long-term-outcomes-associated-with-total-arterial-revascularization-vs-non-total-arterial-revascularization\/","title":{"rendered":"Long-term outcomes associated with total arterial revascularization vs non\u2013total arterial revascularization"},"content":{"rendered":"<p><strong>Importance <\/strong>&#x2014; The optimal conduits for coronary artery bypass grafting (CABG) remain controversial in multivessel coronary artery disease.<\/p>\n<p><strong>Objective <\/strong>&#x2014; To compare the long-term clinical outcomes of total arterial revascularization (TAR) vs non-TAR (CABG with at least 1 arterial and 1 saphenous vein graft) in a multicenter population-based study.<\/p>\n<p><span class=\"bold\">Design, Setting, and Participants <\/span>&#x2014; This multicenter population-based cohort study using propensity score matching took place from October 2008 to March 2017 in Ontario, Canada, with a mean and maximum follow-up of 4.6 and 9.0 years, respectively. Individuals with primary isolated CABG were identified, with at least 1 arterial graft. Exclusion criteria were individuals from out of province and younger than 18 years. Patients undergoing a cardiac reoperation or those in cardiogenic shock were also excluded because these conditions would potentially bias the surgeon toward not performing TAR. Analysis began April 2019.<\/p>\n<p><strong>Exposures <\/strong>&#x2014; Total arterial revascularization.<\/p>\n<p><span class=\"bold\">Main Outcomes and Measures <\/span>&#x2014; Primary outcome was time to first event of a composite of death, myocardial infarction, stroke, or repeated revascularization (major adverse cardiac and cerebrovascular events). Secondary outcomes included the individual components of the primary outcome.<\/p>\n<p><strong>Results <\/strong>&#x2014; Of 49 404 individuals with primary isolated CABG, 2433 (4.9%) received TAR, with the total number of bypasses being 2, 3, and 4 or more vessels in 1521 (62.5%), 865 (35.6%), and 47 individuals (1.9%), respectively. The mean (SD) age was 61.2 (10.4) years and 1983 (81.5%) were men. After propensity score matching, 2132 patient pairs were formed, with equal total number of bypasses (mean [SD], 2.4 [0.5]) but with more arterial grafts in the TAR group (mean [SD], 2.4 [0.5] vs 1.2 [0.4]; P &lt; .01). In-hospital death (15 [0.7%] vs 21 [1.0%]; P = .32) did not differ between TAR vs non-TAR groups after propensity score matching. Throughout 8 years, TAR was associated with improved freedom from major adverse cardiac and cerebrovascular events (hazard ratio, 0.78; 95% CI, 0.68-0.89), death (hazard ratio, 0.80; 95% CI, 0.66-0.97), and myocardial infarction (hazard ratio, 0.69; 95% CI, 0.51-0.92). There was no difference in stroke and repeated revascularization.<\/p>\n<p><span class=\"bold\">Conclusions and Relevance<\/span> &#x2014; Total arterial revascularization was associated with improved long-term freedom from major adverse cardiac and cerebrovascular events, death, and myocardial infarction and may be the procedure of choice for patients with reasonable life expectancy requiring CABG.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Importance &#x2014; The optimal conduits for coronary artery bypass grafting (CABG) remain controversial in multivessel coronary artery disease. Objective &#x2014; To compare the long-term clinical outcomes of total arterial revascularization (TAR) vs non-TAR (CABG with at least 1 arterial and 1 saphenous vein graft) in a multicenter population-based study. Design, Setting, and Participants &#x2014; This [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[],"migration-helper-qa-sample-set":[],"class_list":["post-2991","journal_article","type-journal_article","status-publish","hentry"],"acf":{"citation":"Rocha RV, Tam DY, Karkhanis R, Wang X, Austin PC, Ko DT, Gaudino M, Royse A, Fremes SE. <em>JAMA Cardiol<\/em>. 2020; 5(5):507-14. Epub 2020 Feb 19.","source_url":"https:\/\/doi.org\/10.1001\/jamacardio.2019.6104","ices_scientist":[1385,1146],"site":[6733],"research_program":[6742],"news_release":[],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"D0312763-D4DB-41B2-9FAB-BFE4B88613FB","sitecore_item_name":"Long-term-outcomes-associated-with-total-arterial-revascularization-vs-non-total-arterial","sitecore_field_values":"{\n  \"Title\": \"Long-term outcomes associated with total arterial revascularization vs non\u2013total arterial revascularization\",\n  \"Short title\": \"Long-term outcomes associated with\",\n  \"Summary\": \"The aim of this study was to compare the long-term clinical outcomes of total arterial revascularization vs non-TAR in a multicenter population-based study.\",\n  \"Citation\": \"<p>Rocha RV, Tam DY, Karkhanis R, Wang X, Austin PC, Ko DT, Gaudino M, Royse A, Fremes SE. <em>JAMA Cardiol<\/em>. 2020; 5(5):507-14. Epub 2020 Feb 19. DOI: <a href=\"https:\/\/doi.org\/10.1001\/jamacardio.2019.6104\" title=\"opens external link\">https:\/\/doi.org\/10.1001\/jamacardio.2019.6104<\/a><\/p>\",\n  \"Abstract\": \"<p><strong>Importance <\/strong>&mdash; The optimal conduits for coronary artery bypass grafting (CABG) remain controversial in multivessel coronary artery disease.<\/p>n<p><strong>Objective <\/strong>&mdash; To compare the long-term clinical outcomes of total arterial revascularization (TAR) vs non-TAR (CABG with at least 1 arterial and 1 saphenous vein graft) in a multicenter population-based study.<\/p>n<p><span class=\"bold\">Design, Setting, and Participants <\/span>&mdash; This multicenter population-based cohort study using propensity score matching took place from October 2008 to March 2017 in Ontario, Canada, with a mean and maximum follow-up of 4.6 and 9.0 years, respectively. Individuals with primary isolated CABG were identified, with at least 1 arterial graft. Exclusion criteria were individuals from out of province and younger than 18 years. Patients undergoing a cardiac reoperation or those in cardiogenic shock were also excluded because these conditions would potentially bias the surgeon toward not performing TAR. Analysis began April 2019.<\/p>n<p><strong>Exposures <\/strong>&mdash; Total arterial revascularization.<\/p>n<p><span class=\"bold\">Main Outcomes and Measures <\/span>&mdash; Primary outcome was time to first event of a composite of death, myocardial infarction, stroke, or repeated revascularization (major adverse cardiac and cerebrovascular events). Secondary outcomes included the individual components of the primary outcome.<\/p>n<p><strong>Results <\/strong>&mdash; Of 49 404 individuals with primary isolated CABG, 2433 (4.9%) received TAR, with the total number of bypasses being 2, 3, and 4 or more vessels in 1521 (62.5%), 865 (35.6%), and 47 individuals (1.9%), respectively. The mean (SD) age was 61.2 (10.4) years and 1983 (81.5%) were men. After propensity score matching, 2132 patient pairs were formed, with equal total number of bypasses (mean [SD], 2.4 [0.5]) but with more arterial grafts in the TAR group (mean [SD], 2.4 [0.5] vs 1.2 [0.4]; P &lt; .01). In-hospital death (15 [0.7%] vs 21 [1.0%]; P = .32) did not differ between TAR vs non-TAR groups after propensity score matching. Throughout 8 years, TAR was associated with improved freedom from major adverse cardiac and cerebrovascular events (hazard ratio, 0.78; 95% CI, 0.68-0.89), death (hazard ratio, 0.80; 95% CI, 0.66-0.97), and myocardial infarction (hazard ratio, 0.69; 95% CI, 0.51-0.92). There was no difference in stroke and repeated revascularization.<\/p>n<p><span class=\"bold\">Conclusions and Relevance<\/span> &mdash; Total arterial revascularization was associated with improved long-term freedom from major adverse cardiac and cerebrovascular events, death, and myocardial infarction and may be the procedure of choice for patients with reasonable life expectancy requiring CABG.<\/p>\",\n  \"Research Programs\": \"{BEC72DE0-BA8C-42B8-ACE5-EE29FFB2CB3B}\",\n  \"ICES Locations\": \"{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}\",\n  \"ICES Scientists\": \"{7D498E8B-5801-4F9E-AC41-11ED50F3C34E}|{B3827152-93D1-4FB2-B106-590CB331A264}\",\n  \"Posted Date\": \"20200219T000000\",\n  \"Show on Publications Landing Page\": \"1\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2020\/February\/Long-term-outcomes-associated-with-total-arterial-revascularization-vs-non-total-arterial"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Long-term outcomes associated with total arterial revascularization vs non\u2013total arterial revascularization<\/title>\n<meta name=\"description\" content=\"Importance &#x2014; 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