Chronic total occlusions and coronary artery bypass grafting outcomes

• Published in: The Journal of thoracic and cardiovascular surgery
• Main Authors: Gikandi, Ajami, Stock, Eileen M., Dematt, Ellen, Quin, Jacquelyn, Hirji, Sameer, Biswas, Kousick, Zenati, Marco A.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 21.08.2024
• Subjects: chronic total occlusion; coronary artery bypass grafting; outcomes; veterans; CTO-PCI; LCx; REGROUP; veterans; SAQ; CI; aHR; HR; LV; VA; LAD; CTO-CABG; RCA; outcomes; MACE; PCI; chronic total occlusion; CABG; coronary artery bypass grafting; CTO
• ISSN: 0022-5223; 1097-685X; 1097-685X
• DOI: 10.1016/j.jtcvs.2024.08.016

To investigate the association between the presence and grafting of chronic total occlusions (CTOs) and coronary artery bypass grafting (CABG) outcomes. This was a post hoc analysis of the Randomized Endograft vs Open Prospective (REGROUP) trial, which randomized veterans undergoing isolated on-pump CABG to endoscopic versus open vein harvest (2014-2017). Patients were stratified on the basis of the presence of at least 1 CTO vessel (a 100% occluded coronary lesion for greater than or equal to 3 months) and according to whether all CTO vessels were bypassed. Rates of major cardiac adverse events (MACE) were compared. At least 1 CTO was present in 453 of 1149 patients (39.4%). Over a median follow-up of 4.7 years (interquartile range, 3.84-5.45), MACE rates were 23.4% versus 22.2% for the CTO versus no CTO group, respectively (adjusted hazard ratio [aHR], 0.92; 95% confidence interval [CI], 0.70-1.20). MACE rates for patients with complete CTO grafting versus not were 23.1% versus 25.0%, respectively (aHR, 0.95; 95% CI, 0.57-1.57). In patients with right coronary dominance undergoing left anterior descending artery grafting, bypassing a right coronary artery CTO was associated with significantly lower rates of all-cause mortality (aHR, 0.38; 95% CI, 0.17-0.83). In this REGROUP trial subanalysis, neither CTO presence or complete grafting of CTO vessels was associated with significantly different rates of MACE. However, the finding of possible survival benefit among a subgroup of patients undergoing grafting of a dominant RCA CTO vessel alongside left anterior descending artery grafting warrants additional study. [Display omitted]