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Sequential vein bypass grafting is not associated with an increase of either in-hospital or mid-term adverse events in off-pump coronary artery bypass grafting.

Xiao F, Wang J, Wu H, Sun H - Chin. Med. J. (2015)

Bottom Line: No significant difference was observed among the groups in baseline characteristics.Individual in-hospital measurement also did not differ significantly between the two groups.At about four years follow-up, the survival estimates free from MACEs (92.5% vs. 97.3%, P = 0.36) and survival rates free of angina recurrence (80.9% vs. 85.5%, P = 0.48) were similar among individual and sequential venous grafts groups with a mean follow-up of 22.5 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China.

ABSTRACT

Background: The impact of sequential vein bypass grafting on clinical outcomes is less known in off-pump coronary artery bypass grafting (CABG). We aimed to evaluate the effects of sequential vein bypass grafting on clinical outcomes in off-pump CABG.

Methods: From October 2009 to September 2013 at the Fuwai Hospital, 127 patients with at least one sequential venous graft were matched with 127 patients of individual venous grafts only, using propensity score matching method to obtain risk-adjusted outcome comparison. In-hospital measurement was composite outcome of in-hospital death, myocardial infarction (MI), stroke, requirement for intra-aortic ballon pump (IABP) assistance and prolonged ventilation. Major adverse cardiac events (MACEs: Death, MI or repeat revascularization) and angina recurrence were considered as mid-term endpoints.

Results: No significant difference was observed among the groups in baseline characteristics. Intraoperative mean blood flow per vein graft was 40.4 ml in individual venous grafts groups versus 59.5 ml in sequential venous grafts groups (P < 0.001). There were no differences between individual and sequential venous grafts groups with regard to composite outcome of in-hospital mortality, MI, stroke, IABP assistance and prolonged ventilation (11.0% vs. 14.2%, P = 0.45). Individual in-hospital measurement also did not differ significantly between the two groups. At about four years follow-up, the survival estimates free from MACEs (92.5% vs. 97.3%, P = 0.36) and survival rates free of angina recurrence (80.9% vs. 85.5%, P = 0.48) were similar among individual and sequential venous grafts groups with a mean follow-up of 22.5 months. In the Cox regression analysis, sequential vein bypass grafting was not identified as an independent predictor of both MACEs and angina recurrence.

Conclusions: Compared to individual vein bypass grafting, sequential vein bypass grafting was not associated with an increase of either in-hospital or mid-term adverse events in patients undergoing off-pump CABG.

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Event-free Kaplan-Meier Estimates for individual venous grafts group and sequential venous grafts group respectivly. Shown are percent survival free from MACE (a) and survival free of angina recurrence (b). MACE: Major adverse cardiac events.
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Figure 1: Event-free Kaplan-Meier Estimates for individual venous grafts group and sequential venous grafts group respectivly. Shown are percent survival free from MACE (a) and survival free of angina recurrence (b). MACE: Major adverse cardiac events.

Mentions: Major adverse cardiac events occurred in six (4.7%) patients (two deaths, two MIs and two PCIs) in individual venous grafts group and two (1.6%) patients (two MIs) in sequential venous grafts group. The Kaplan-Meier MACE-free survival estimates at about four years were 92.5% and 97.3% in the individual and sequential venous grafts group respectively (P = 0.36; Figure 1a). The HR for sequential vein bypass grafting was estimated at 0.21 (95% CI, 0.03–1.85, P = 0.16). The survival rates free of angina recurrence at about 4 years was 80.9% in patients receiving individual venous grafts only versus 85.5% in patients receiving sequential venous grafts (P = 0.48; Figure 1b), with HR for sequential vein bypass grafting at 0.70 (95% CI, 0.27–1.83, P = 0.47).


Sequential vein bypass grafting is not associated with an increase of either in-hospital or mid-term adverse events in off-pump coronary artery bypass grafting.

Xiao F, Wang J, Wu H, Sun H - Chin. Med. J. (2015)

Event-free Kaplan-Meier Estimates for individual venous grafts group and sequential venous grafts group respectivly. Shown are percent survival free from MACE (a) and survival free of angina recurrence (b). MACE: Major adverse cardiac events.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4837821&req=5

Figure 1: Event-free Kaplan-Meier Estimates for individual venous grafts group and sequential venous grafts group respectivly. Shown are percent survival free from MACE (a) and survival free of angina recurrence (b). MACE: Major adverse cardiac events.
Mentions: Major adverse cardiac events occurred in six (4.7%) patients (two deaths, two MIs and two PCIs) in individual venous grafts group and two (1.6%) patients (two MIs) in sequential venous grafts group. The Kaplan-Meier MACE-free survival estimates at about four years were 92.5% and 97.3% in the individual and sequential venous grafts group respectively (P = 0.36; Figure 1a). The HR for sequential vein bypass grafting was estimated at 0.21 (95% CI, 0.03–1.85, P = 0.16). The survival rates free of angina recurrence at about 4 years was 80.9% in patients receiving individual venous grafts only versus 85.5% in patients receiving sequential venous grafts (P = 0.48; Figure 1b), with HR for sequential vein bypass grafting at 0.70 (95% CI, 0.27–1.83, P = 0.47).

Bottom Line: No significant difference was observed among the groups in baseline characteristics.Individual in-hospital measurement also did not differ significantly between the two groups.At about four years follow-up, the survival estimates free from MACEs (92.5% vs. 97.3%, P = 0.36) and survival rates free of angina recurrence (80.9% vs. 85.5%, P = 0.48) were similar among individual and sequential venous grafts groups with a mean follow-up of 22.5 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China.

ABSTRACT

Background: The impact of sequential vein bypass grafting on clinical outcomes is less known in off-pump coronary artery bypass grafting (CABG). We aimed to evaluate the effects of sequential vein bypass grafting on clinical outcomes in off-pump CABG.

Methods: From October 2009 to September 2013 at the Fuwai Hospital, 127 patients with at least one sequential venous graft were matched with 127 patients of individual venous grafts only, using propensity score matching method to obtain risk-adjusted outcome comparison. In-hospital measurement was composite outcome of in-hospital death, myocardial infarction (MI), stroke, requirement for intra-aortic ballon pump (IABP) assistance and prolonged ventilation. Major adverse cardiac events (MACEs: Death, MI or repeat revascularization) and angina recurrence were considered as mid-term endpoints.

Results: No significant difference was observed among the groups in baseline characteristics. Intraoperative mean blood flow per vein graft was 40.4 ml in individual venous grafts groups versus 59.5 ml in sequential venous grafts groups (P < 0.001). There were no differences between individual and sequential venous grafts groups with regard to composite outcome of in-hospital mortality, MI, stroke, IABP assistance and prolonged ventilation (11.0% vs. 14.2%, P = 0.45). Individual in-hospital measurement also did not differ significantly between the two groups. At about four years follow-up, the survival estimates free from MACEs (92.5% vs. 97.3%, P = 0.36) and survival rates free of angina recurrence (80.9% vs. 85.5%, P = 0.48) were similar among individual and sequential venous grafts groups with a mean follow-up of 22.5 months. In the Cox regression analysis, sequential vein bypass grafting was not identified as an independent predictor of both MACEs and angina recurrence.

Conclusions: Compared to individual vein bypass grafting, sequential vein bypass grafting was not associated with an increase of either in-hospital or mid-term adverse events in patients undergoing off-pump CABG.

Show MeSH
Related in: MedlinePlus