Clinical Insights to Complete and Incomplete Surgical Revascularization in Atrial Fibrillation and Multivessel Coronary Disease
ObjectivesAlthough endorsed by international guidelines, complete revascularization (CR) with Coronary Artery Bypass Grafting (CABG) remains underused. In higher-risk patients such as those with pre-operative atrial fibrillation (AF), the effects of CR are not well studied.MethodsWe analyzed patient...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.910811/full |
| _version_ | 1811335192963448832 |
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| author | Michal Pasierski Michal Pasierski Jakub Staromłyński Jakub Staromłyński Janina Finke Radoslaw Litwinowicz Radoslaw Litwinowicz Grzegorz Filip Adam Kowalówka Adam Kowalówka Wojciech Wańha Wojciech Wańha Michalina Kołodziejczak Michalina Kołodziejczak Michalina Kołodziejczak Natalia Piekuś-Słomka Andrzej Łoś Sebastian Stefaniak Wojciech Wojakowski Marek Jemielity Jan Rogowski Marek Deja Marek Deja Dariusz Jagielak Krzysztof Bartus Silvia Mariani Tong Li Matteo Matteucci Matteo Matteucci Daniele Ronco Daniele Ronco Federica Jiritano Federica Jiritano Dario Fina Dario Fina Gennaro Martucci Gennaro Martucci Paolo Meani Paolo Meani Giuseppe Maria Raffa Giuseppe Maria Raffa Artur Słomka Artur Słomka Pietro Giorgio Malvidni Roberto Lorusso Michal Zembala Piotr Suwalski Mariusz Kowalewski Mariusz Kowalewski Mariusz Kowalewski |
| author_facet | Michal Pasierski Michal Pasierski Jakub Staromłyński Jakub Staromłyński Janina Finke Radoslaw Litwinowicz Radoslaw Litwinowicz Grzegorz Filip Adam Kowalówka Adam Kowalówka Wojciech Wańha Wojciech Wańha Michalina Kołodziejczak Michalina Kołodziejczak Michalina Kołodziejczak Natalia Piekuś-Słomka Andrzej Łoś Sebastian Stefaniak Wojciech Wojakowski Marek Jemielity Jan Rogowski Marek Deja Marek Deja Dariusz Jagielak Krzysztof Bartus Silvia Mariani Tong Li Matteo Matteucci Matteo Matteucci Daniele Ronco Daniele Ronco Federica Jiritano Federica Jiritano Dario Fina Dario Fina Gennaro Martucci Gennaro Martucci Paolo Meani Paolo Meani Giuseppe Maria Raffa Giuseppe Maria Raffa Artur Słomka Artur Słomka Pietro Giorgio Malvidni Roberto Lorusso Michal Zembala Piotr Suwalski Mariusz Kowalewski Mariusz Kowalewski Mariusz Kowalewski |
| author_sort | Michal Pasierski |
| collection | DOAJ |
| description | ObjectivesAlthough endorsed by international guidelines, complete revascularization (CR) with Coronary Artery Bypass Grafting (CABG) remains underused. In higher-risk patients such as those with pre-operative atrial fibrillation (AF), the effects of CR are not well studied.MethodsWe analyzed patients’ data from the HEIST (HEart surgery In AF and Supraventricular Tachycardia) registry. Between 2012 and 2020 we identified 4770 patients with pre-operative AF and multivessel coronary artery disease who underwent isolated CABG. We divided the cohort according to the completeness of the revascularization and used propensity score matching (PSM) to minimize differences between baseline characteristics. The primary endpoint was all-cause mortality.ResultsMedian follow-up was 4.7 years [interquartile range (IQR) 2.3–6.9]. PSM resulted in 1,009 pairs of complete and incomplete revascularization. Number of distal anastomoses varied, accounting for 3.0 + –0.6 vs. 1.7 + –0.6, respectively. Although early (< 24 h) and 30-day post-operative mortalities were not statistically different between non-CR and CR patients [Odds Ratio (OR) and 95% Confidence Intervals (CIs): 1.34 (0.46–3.86); P = 0.593, Hazard Ratio (HR) and 95% CIs: 0.88 (0.59–1.32); P = 0.542, respectively] the long term mortality was nearly 20% lower in the CR cohort [HR (95% CIs) 0.83 (0.71–0.96); P = 0.011]. This benefit was sustained throughout subgroup analyses, yet most accentuated in low-risk patients (younger i.e., < 70 year old, with a EuroSCORE II < 2%, non-diabetic) and when off-pump CABG was performed.ConclusionComplete revascularization in patients with pre-operative AF is safe and associated with improved survival. Particular survival benefit with CR was observed in low-risk patients undergoing off-pump CABG. |
| first_indexed | 2024-04-13T17:20:32Z |
| format | Article |
| id | doaj.art-80ebd92382fe482591e4b7eaf04feb27 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-13T17:20:32Z |
| publishDate | 2022-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-80ebd92382fe482591e4b7eaf04feb272022-12-22T02:37:59ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-06-01910.3389/fcvm.2022.910811910811Clinical Insights to Complete and Incomplete Surgical Revascularization in Atrial Fibrillation and Multivessel Coronary DiseaseMichal Pasierski0Michal Pasierski1Jakub Staromłyński2Jakub Staromłyński3Janina Finke4Radoslaw Litwinowicz5Radoslaw Litwinowicz6Grzegorz Filip7Adam Kowalówka8Adam Kowalówka9Wojciech Wańha10Wojciech Wańha11Michalina Kołodziejczak12Michalina Kołodziejczak13Michalina Kołodziejczak14Natalia Piekuś-Słomka15Andrzej Łoś16Sebastian Stefaniak17Wojciech Wojakowski18Marek Jemielity19Jan Rogowski20Marek Deja21Marek Deja22Dariusz Jagielak23Krzysztof Bartus24Silvia Mariani25Tong Li26Matteo Matteucci27Matteo Matteucci28Daniele Ronco29Daniele Ronco30Federica Jiritano31Federica Jiritano32Dario Fina33Dario Fina34Gennaro Martucci35Gennaro Martucci36Paolo Meani37Paolo Meani38Giuseppe Maria Raffa39Giuseppe Maria Raffa40Artur Słomka41Artur Słomka42Pietro Giorgio Malvidni43Roberto Lorusso44Michal Zembala45Piotr Suwalski46Mariusz Kowalewski47Mariusz Kowalewski48Mariusz Kowalewski49Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, PolandThoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, PolandDepartment of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, PolandThoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, PolandDepartment of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, PolandThoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, PolandDepartment of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, PolandDepartment of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, PolandDepartment of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, PolandDepartment of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, PolandThoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, PolandDepartment of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, PolandThoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, PolandDepartment of Anaesthesiology and Intensive Care, Antoni Jurasz University Hospital No. 1, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, PolandDivision of Cardiology, Yale School of Medicine, New Haven, CT, United StatesDepartment of Inorganic and Analytical Chemistry, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland0Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland1Department of Cardiac Surgery and Transplantology, Poznań University of Medical Sciences, Poznań, PolandDepartment of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland1Department of Cardiac Surgery and Transplantology, Poznań University of Medical Sciences, Poznań, Poland0Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, PolandDepartment of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, PolandDepartment of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland0Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, PolandDepartment of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland2Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands3Department of Cardiac Surgery, University Hospital Düesseldorf, Düesseldorf, GermanyThoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland4Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, ItalyThoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland4Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, ItalyThoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland5Department of Cardiac Surgery, University Magna Græcia of Catanzaro, Catanzaro, ItalyThoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland6Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Unit (ICU), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, Milan, ItalyThoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland7Anesthesia and Intensive Care Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, ItalyThoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland6Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Unit (ICU), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, Milan, ItalyThoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland8Cardiac Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, ItalyThoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland9Department of Pathophysiology, Ludwik Rydygier Collegium Medicum Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland0Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy2Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands1Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases, Zabrze, PolandDepartment of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, PolandDepartment of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, PolandThoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland2Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, NetherlandsObjectivesAlthough endorsed by international guidelines, complete revascularization (CR) with Coronary Artery Bypass Grafting (CABG) remains underused. In higher-risk patients such as those with pre-operative atrial fibrillation (AF), the effects of CR are not well studied.MethodsWe analyzed patients’ data from the HEIST (HEart surgery In AF and Supraventricular Tachycardia) registry. Between 2012 and 2020 we identified 4770 patients with pre-operative AF and multivessel coronary artery disease who underwent isolated CABG. We divided the cohort according to the completeness of the revascularization and used propensity score matching (PSM) to minimize differences between baseline characteristics. The primary endpoint was all-cause mortality.ResultsMedian follow-up was 4.7 years [interquartile range (IQR) 2.3–6.9]. PSM resulted in 1,009 pairs of complete and incomplete revascularization. Number of distal anastomoses varied, accounting for 3.0 + –0.6 vs. 1.7 + –0.6, respectively. Although early (< 24 h) and 30-day post-operative mortalities were not statistically different between non-CR and CR patients [Odds Ratio (OR) and 95% Confidence Intervals (CIs): 1.34 (0.46–3.86); P = 0.593, Hazard Ratio (HR) and 95% CIs: 0.88 (0.59–1.32); P = 0.542, respectively] the long term mortality was nearly 20% lower in the CR cohort [HR (95% CIs) 0.83 (0.71–0.96); P = 0.011]. This benefit was sustained throughout subgroup analyses, yet most accentuated in low-risk patients (younger i.e., < 70 year old, with a EuroSCORE II < 2%, non-diabetic) and when off-pump CABG was performed.ConclusionComplete revascularization in patients with pre-operative AF is safe and associated with improved survival. Particular survival benefit with CR was observed in low-risk patients undergoing off-pump CABG.https://www.frontiersin.org/articles/10.3389/fcvm.2022.910811/fullatrial fibrillationCABGcomplete revascularizationsurvivallong-term |
| spellingShingle | Michal Pasierski Michal Pasierski Jakub Staromłyński Jakub Staromłyński Janina Finke Radoslaw Litwinowicz Radoslaw Litwinowicz Grzegorz Filip Adam Kowalówka Adam Kowalówka Wojciech Wańha Wojciech Wańha Michalina Kołodziejczak Michalina Kołodziejczak Michalina Kołodziejczak Natalia Piekuś-Słomka Andrzej Łoś Sebastian Stefaniak Wojciech Wojakowski Marek Jemielity Jan Rogowski Marek Deja Marek Deja Dariusz Jagielak Krzysztof Bartus Silvia Mariani Tong Li Matteo Matteucci Matteo Matteucci Daniele Ronco Daniele Ronco Federica Jiritano Federica Jiritano Dario Fina Dario Fina Gennaro Martucci Gennaro Martucci Paolo Meani Paolo Meani Giuseppe Maria Raffa Giuseppe Maria Raffa Artur Słomka Artur Słomka Pietro Giorgio Malvidni Roberto Lorusso Michal Zembala Piotr Suwalski Mariusz Kowalewski Mariusz Kowalewski Mariusz Kowalewski Clinical Insights to Complete and Incomplete Surgical Revascularization in Atrial Fibrillation and Multivessel Coronary Disease Frontiers in Cardiovascular Medicine atrial fibrillation CABG complete revascularization survival long-term |
| title | Clinical Insights to Complete and Incomplete Surgical Revascularization in Atrial Fibrillation and Multivessel Coronary Disease |
| title_full | Clinical Insights to Complete and Incomplete Surgical Revascularization in Atrial Fibrillation and Multivessel Coronary Disease |
| title_fullStr | Clinical Insights to Complete and Incomplete Surgical Revascularization in Atrial Fibrillation and Multivessel Coronary Disease |
| title_full_unstemmed | Clinical Insights to Complete and Incomplete Surgical Revascularization in Atrial Fibrillation and Multivessel Coronary Disease |
| title_short | Clinical Insights to Complete and Incomplete Surgical Revascularization in Atrial Fibrillation and Multivessel Coronary Disease |
| title_sort | clinical insights to complete and incomplete surgical revascularization in atrial fibrillation and multivessel coronary disease |
| topic | atrial fibrillation CABG complete revascularization survival long-term |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.910811/full |
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