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Thorac Cardiovasc Surg 2023; 71(06): 462-468
DOI: 10.1055/s-0043-1761625
Original Cardiovascular

Revascularization of Occluded Right Coronary Artery and Outcome After Coronary Artery Bypass Grafting

Fausto Biancari
1   Hear and Lung Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
2   Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
3   Department of Medicine, University of Helsinki, South-Karelia Central Hospital, Lappeenranta, Finland
,
Magnus Dalén
4   Department of Molecular Medicine and Surgery and Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
,
Tuomas Tauriainen
1   Hear and Lung Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
2   Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
,
Giuseppe Gatti
5   Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
,
Antonio Salsano
6   Division of Cardiac Surgery, Ospedale Policlinico San Marino, University of Genoa, Genoa, Italy
,
Francesco Santini
6   Division of Cardiac Surgery, Ospedale Policlinico San Marino, University of Genoa, Genoa, Italy
,
Marisa De Feo
7   Department of Cardiothoracic Sciences, University of Campania “Luigi Vanvitelli,” Monaldi Hospital, Naples, Italy
,
Qiyao Zhang
4   Department of Molecular Medicine and Surgery and Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
,
Enzo Mazzaro
5   Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
,
Ilaria Franzese
5   Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
,
Ciro Bancone
7   Department of Cardiothoracic Sciences, University of Campania “Luigi Vanvitelli,” Monaldi Hospital, Naples, Italy
,
Marco Zanobini
8   Cardiovascular Department, IRCCS Centro Cardiologico Monzino, Milan, Italy
,
Timo Mäkikallio
3   Department of Medicine, University of Helsinki, South-Karelia Central Hospital, Lappeenranta, Finland
,
Matteo Saccocci
9   Cardiac Surgery Unit, Poliambulanza Foundation, Brescia, Italy
,
Alessandra Francica
10   Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
,
Francesco Onorati
10   Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
,
Zein El-Dean
11   Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
,
Giovanni Mariscalco
11   Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
› Author Affiliations Funding None.
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Abstract

Objectives The aim of the present study was to evaluate the results of isolated coronary artery bypass grafting (CABG) with or without revascularization of the occluded right coronary artery (RCA).

Methods Patients undergoing isolated CABG were included in a prospective European multicenter registry. Outcomes were adjusted for imbalance in preoperative variables with propensity score matching analysis. Late outcomes were evaluated with Kaplan–Meier's method and competing risk analysis.

Results Out of 2,948 included in this registry, 724 patients had a total occlusion of the RCA and were the subjects of this analysis. Occluded RCA was not revascularized in 251 (34.7%) patients with significant variability between centers. Among 245 propensity score-matched pairs, patients with and without revascularization of occluded RCA had similar early outcomes. The nonrevascularized RCA group had increased rates of 5-year all-cause mortality (17.7 vs. 11.7%, p = 0.039) compared with patients who had their RCA revascularized. The rates of myocardial infarction and repeat revascularization were only numerically increased but contributed to a significantly higher rate of MACCE (24.7 vs. 15.7%, p = 0.020) at 5 year among patients with nonrevascularized RCA.

Conclusion In this multicenter study, one-third of totally occluded RCAs was not revascularized during isolated CABG for multivessel coronary artery disease. Failure to revascularize an occluded RCA in these patients increased the risk of all-cause mortality and MACCEs at 5 years.

Keywords

coronary artery bypass grafting - percutaneous coronary intervention - myocardial infarction - repeat revascularization - right coronary artery - major cardiac and cerebrovascular events

Ethical Approval for Research

The Institutional Review Board or Ethical Committee of each participating center approved this study.


Authors' Contribution

F.B. was responsible for conceptualization, methodology, and formal analysis; F.B. and Z.E.D. were responsible for software; F.B. and G.M. were responsible for validation; F.B., M.D., T.T., G.G., A.S., F.S., M.D.F., Q.Z, E.M., I.F., C.B., M.Z., T.M., M.S., A.F., F.O., Z.E.D., and G.M. were responsible for investigation and data curation; F.B., M.D., and G.M. were responsible for writing—original draft; F.B., M.D., T.T., G.G., A.S., F.S., M.D.F., Q.Z, E.M., I.F., C.B., M.Z., T.M., M.S., A.F., F.O., Z.E.D., G.M were responsible for writing—review and editing.


Clinical Trial Registration

https://clinicaltrials.gov. Unique identified: NCT02319083.




Publication History

Received: 07 October 2022

Accepted: 03 January 2023

Article published online:
03 February 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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