Impact of Functional vs Anatomic Complete Revascularization in Coronary Artery Bypass Grafting

BACKGROUND This study was conducted to evaluate the impact of functional and anatomic complete revasculari-zation on long-term clinical outcomes after coronary artery bypass grafting (CABG). METHODS Of 2034 patients who underwent primary isolated CABG between 2006 and 2017, 1162 patients who un-derwent off-pump CABG for 3-vessel disease and for whom data on functional and anatomic completeness of revas-cularization were available on the basis of preoperative myocardial single photon emission computed tomography and early postoperative graft angiography were enrolled. The median follow-up duration was 82.4 months (interquartile range, 50.8-122.4 months). Univariate and multivariate analyses were performed to evaluate the impact of the functional and anatomic completeness of revascularization on long-term survival. RESULTS Of 1162 patients, anatomic complete revascularization was achieved in 1014 patients (87.3%), whereas functional complete revascularization was achieved in 1077 patients (92.7%). Early mortality occurred in 7 patients. Late death occurred in 322 of 1155 early survivors. The 5-and 10-year overall survival rates were 84.3% and 66.7%, respectively. Univariate analyses demonstrated that functional completeness of revascularization was a statistically significant risk factor (P = .038), whereas anatomic completeness was not (P = .859). The multivariate analysis showed that functional completeness of revascularization (hazard ratio, 1.54; 95% CI, 1.08-2.22; P = .019) and age, underweight status, diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, and left ventricular dysfunction were significant factors associated with long-term survival. CONCLUSIONS Functional rather than anatomic completeness of revascularization has a significant impact on the long-term survival in patients who undergo CABG.