BACKGROUND:
Complete revascularization (CRV) has been the gold standard for CABG. However, CABG has evolved with increasing use of arterial conduits and off-pump coronary artery bypass (OPCAB) techniques. It is unclear whether CRV remains important.
METHODS:
We used our prospective surgical database to compare patients undergoing isolated CABG from January 1998 to December 2000. Patients were followed via annual questionnaires and telephone contact to confirm outcomes. Incomplete revascularization (IRV) was defined as the lack of one or more bypass grafts placed to a region supplied by a vessel with >=50% stenosis.
RESULTS:
1187 patients were reviewed. Follow-up was available for 1168 (98%), mean 2.2±1.5 years. CRV was found in 88.8% (1054/1187) and IRV in 11.2% (133/1187). 80.4% (954/1187) were performed On-pump and 19.6% (233/1187) were OPCAB. IRV was more prevalent in OPCAB surgeries, 24.0% (56/233) versus 8.1% (77/954) On-pump, (p<0.001). Multivariable logistic regression analysis indicated that predictors of death were; Age (OR=1.06, p<0.001), CHF (OR=3.10, p<0.001), DM (OR=1.53, p=0.036) and IRV (OR=2.11, p=0.001). Predictors for IRV were; CHF (OR=1.91, p=0.009), Prior Surgery (OR=5.00, p<0.001), Female sex (OR=2.0, p<0.001), Off-pump Surgery (OR=7.28, p<0.001) and increasing Number of Diseased Coronary Territories (OR=2.24, p<0.001). Actuarial survival estimates at 4 years were 86% for CRV patients and 59% for IRV (p<0.001).
CONCLUSIONS:
Complete revascularization demonstrates greater survival 4-years postoperatively in both on and off pump CABG patients. Survival in OPCAB was worse due to more incomplete revascularization. To maximize survival, complete revascularization should be performed whenever possible.

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