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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Complete surgical revascularization: the impact of the different definitions on mortality
Session:
CO - Prémio Machado Macedo
Speaker:
Paulo Alexandre Veiga de Oliveira
Congress:
CPC 2019
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.1 Cardiovascular Surgery – Coronary Arteries
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Paulo Veiga Oliveira; Márcio Madeira; Sara Ranchordás; Catarina Brízido; Tiago Nolasco; João Roque; Sérgio Boshoff; Marta Marques; Luís Bruges; Manuel Almeida; Rui Campante Teles; José Calquinha; António Ventosa; Miguel Sousa Uva; Miguel Abecasis; José Pedro Neves
Abstract
<p><strong>Introduction</strong></p> <p>The concept of complete revascularization arises from the early stages on coronary artery bypass grafting (CABG). Despite the established importance of complete revascularization, there is no agreement which of several definitions has most impact on mortality.</p> <p><strong>Objectives</strong></p> <p>To determine the relation between different definitions of complete surgical revascularization with late mortality.</p> <p><strong>Methods</strong></p> <p>Single center retrospective study of all consecutive patients submitted to isolated CABG with previous myocardial viability assessment (myocardial perfusion scintigraphy), since 2011 to 2016, excluding emergent procedures and previous cardiac surgery. The population of study was162 patients with 22,2% female gender and a mean age of 66 years. The follow-up was complete in 98,8%, median time of 4,1 (IQR 3,0-5,5) years. The primary end-point was mortality at follow-up.</p> <p>The completeness of revascularization was classified in all patients according to four different definitions (n=162 for each definition): Numerical (the number of stenotic vessels must equal the number of distal anastomoses applied); Functional (all ischemic myocardial territories are reperfused; areas of old infarction with no viable myocardium are not required to be reperfused); Anatomical Conditional (all stenotic main-branch vessels are revascularized) and Anatomical Unconditional (all stenotic vessels are revascularized, irrespective of size and territory supplied).</p> <p>For each definition, statistical analysis was performed using the Kaplan-Meier method with log rank test and Cox proportional analysis (EuroScore II and revascularization definition).</p> <p><strong>Results</strong></p> <p>On univariate analysis, there was no significant statistical association between each definition of complete revascularization and follow-up mortality (n=20): numerical (p=0,694); anatomical unconditional (p=0,294); but a trend was found on functional (p=0,063) and anatomical conditional (p=0,084).</p> <p>On multivariate analysis, incomplete functional revascularization increased the risk of follow-up mortality in 2,89 folds (CI95% 1,06-7,89 p=0,039) and anatomical conditional in 3,28 folds (CI95% 1,01-10,66 p=0,048) (Figure 1). The other definitions were not statistically associated with late mortality.</p> <p><strong>Conclusion</strong></p> <p>According to this study, complete functional and anatomical conditional revascularization definitions are determinants of follow-up mortality in a multivariate model including EuroScore II. The revascularization of all stenotic main-branch vessels (anatomical conditional) seems to have the highest impact.</p>
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