A1587

JACC March 17, 2015

Volume 65, Issue 10S

Stable Ischemic Heart Disease

Routine Coronary Artery Bypass of Angiographically Borderline Coronary Artery
Stenoses is not Associated with Improved Survival
Moderated Poster Contributions
Stable Ischemic Heart Disease Moderated Poster Theater, Poster Hall B1
Monday, March 16, 2015, 10:15 a.m.-10:25 a.m.
Session Title: Surgical Revascularization for Ischemic Heart Disease
Abstract Category: 27. Stable Ischemic Heart Disease: Therapy
Presentation Number: 1274M-07
Authors: Janek Senaratne, Colleen Norris, Michelle Graham, Jayan Nagendran, Darren Freed, Jonathan Afilalo, Sean Van Diepen,
University of Alberta, Edmonton, Canada

Background: Coronary artery bypass grafting (CABG) improves outcomes in patients with multi-vessel coronary artery disease. Bypass
of angiographically significant lesions 70% is recommended yet there is little evidence to guide decision making for angiographically
borderline 50-69% lesions (ABL), which has led to wide variability in practice patterns.

Methods: Between 2007 and 2013, 3,195 patients in the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease
registry underwent isolated first CABG with at least 2 distal anastomoses. Patients with an isolated ABL (50-69%) of the proximal segment
of a major epicardial coronary vessel (excluding the left main) on the pre-operative angiogram were included in the study. The primary
outcome of interest was long-term mortality.

Results: Among the 350 patients with an ABL, 268 (76.6%) were surgically bypassed. Mean follow-up was 4.2 1.7 years. Patients
with a bypassed ABL tended to be older (62.5 vs 66.1 years, p=0.01) but were otherwise similar in terms of sex, comorbidities, diabetes,
ejection fraction, and number of coronary stenoses. Cardiopulmonary bypass time was longer in patients with bypassed ABL (104.2 vs 90.4
minutes, p<0.001). Compared to non-bypassed ABL, bypassed ABL was associated with a trend towards increased long term mortality
(adjusted odds ratio 2.96: 95% confidence interval, 0.90 - 9.68, p=0.07). Similarly no differences were observed in either 30-day (0.0% vs
1.1%, p=0.336) or 1-year mortality (0.0% vs 4.1%, p=0.062). No interactions between major epicardial ABL vessel location and mortality
were identified. Repeat revascularization of ABL bypass grafts was numerically higher (0.0% vs 4.1%, p = 0.107).
Conclusion: In a large unselected cohort of patients with ABL, bypass of these 50-69% lesions is frequently performed and not associated
with improved long-term survival. Our findings suggest that the routine surgical revascularization of ABLs may not be warranted.

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