Objective To compare postoperative survival rates and the incidence of adverse events in patients with three-vessel disease undergoing complete versus incomplete revascularization during coronary artery bypass grafting (CABG). Methods A retrospective analysis was conducted on patient data from Tianjin Chest Hospital who underwent primary isolated CABG surgery between 2019 and 2020. Patients were divided into a complete revascularization group and an incomplete revascularization group based on the revascularization status after surgery. Inverse probability of treatment weighting (IPTW) was used for risk adjustment. Results A total of 1 419 patients were included in the study, with 1 086 (76.5%) undergoing complete revascularization. IPTW analysis showed that complete revascularization could reduce the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) [HR=0.596, 95%CI (0.404, 0.880), P=0.010] and angina [HR=0.560, 95%CI (0.377, 0.823), P=0.004]. Conclusion In patients with multivessel coronary artery disease, complete revascularization may be associated with improved patient outcomes.
ObjectiveCompare the therapeutic effects of multivessel percutaneous coronary intervention (MV-PCI) and culprit-only revascularization strategy (C-PCI) in percutaneous coronary intervention (PCI) for patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) and multivessel disease (MVD). MethodsThe PubMed, Embase, Cochrane Library, MEDLINE, Web of Science, CENTRAL, CNKI and WanFang Data databases were searched to collect studies comparing C-PCI vs. MV-PCI in patients with AMI and CS from inception to March 2, 2025. Methodological quality of the included studies was assessed using the Newcastle-Ottawa scale (NOS) and the risk of bias (ROB) tool. Meta-analysis was performed using RevMan software (version 5.4.0). ResultsA total of 18 studies (1 randomized controlled trial, 1 post-hoc analysis of a randomized controlled trial, and 16 retrospective observational studies), enrolling 101 693 patients. The results of the observational studies showed that MV-PCI was associated with higher risk of short-term mortality (OR=1.13, 95%CI 1.01 to 1.25, P=0.03), renal replacement therapy (OR=1.41, 95%CI 1.32 to 1.50, P<0.001), and cerebrovascular accident events (OR=1.21, 95%CI 1.10 to 1.33, P<0.001). No significant difference was observed in long-term mortality (OR=0.93, 95%CI 0.74 to 1.16, P=0.51), recurrent myocardial infarction (OR=1.16, 95%CI 0.97 to 1.39, P=0.10), repeat revascularization events (OR=0.83, 95%CI 0.58 to 1.20, P=0.33) and bleeding event rates (OR=1.01, 95%CI 0.71 to 1.34, P=0.97) between groups. The results remained consistent after adding the only randomized trial. ConclusionIn patients with AMICS and concomitant MVD, C-PCI provides comparable survival benefits to MV-PCI and is associated with a reduced risk of all-cause mortality, cerebrovascular events, and the need for renal replacement therapy.
ObjectiveTo compare the perioperative and mid-term follow-up outcomes of patients undergoing coronary endarterectomy combined with coronary artery bypass grafting (CE-CABG) versus those undergoing CABG alone. MethodsA retrospective cohort of 2 070 patients who underwent surgery for coronary artery disease at the Department of Cardiac Surgery, Guangdong Provincial People's Hospital between 2016 and 2024 was included. Patients were excluded if they had missing data, concomitant valve, aortic, or congenital heart surgery, or underwent off-pump CABG. Eligible patients were divided into a CE-CABG group and a CABG group, and 1 : 1 propensity score matching was performed using the "MatchIt" package in R software. ResultsA total of 202 patients were included after matching (172 males, 30 females), with a mean age of (60.3±7.5) years. Baseline characteristics were well-balanced between the two groups (standardized mean difference<0.1 for all covariates). There were no statistical differences in operative mortality (4.0% vs. 4.0%) or early postoperative major adverse cardiovascular and cerebrovascular events (MACCE) (4.0% vs. 5.0%, both P >0.05) between the CE-CABG and CABG groups. The CE-CABG group exhibited significantly prolonged operative time [(401.1±105.9) min vs. (353.3±95.6) min], cardiopulmonary bypass (CPB) time [(206.4±65.2) min vs. (174.6±63.1) min], aortic cross-clamp time [125.0 (101.0, 159.5) min vs. 93.0 (70.0, 126.0) min] and postoperative hospital stay [24.0 (18.5, 33.5) d vs. 21.0 (15.0, 28.0) d] (all P<0.05). During a median follow-up of 33 months (follow-up rate: 93.1%), no statistical differences were observed in all-cause mortality (3.0% vs. 5.5%, P=0.498) or MACCE incidence (14.9% vs. 16.8%, P=0.700) between the two groups. However, the rates of cardiac-related readmission (23.8% vs. 37.6%, P=0.033) and coronary angiography re-examination (13.9% vs. 27.7%, P=0.015) were significantly lower in the CE-CABG group. Conclusion CE-CABG facilitates complete revascularization in patients with diffuse coronary artery disease (DCAD) without increasing operative mortality or the incidence of MACCE. CE-CABG is associated with longer CPB time, aortic cross-clamp time, operative time, and postoperative hospital length of stay. Follow-up results indicate that CE-CABG reduces the rates of cardiac-related readmission and coronary angiography re-examination in patients with DCAD. These findings demonstrate that the CE procedure itself does not increase operative risk and serves as a safe and effective strategy for achieving complete revascularization in patients with DCAD.