Long-term follow-up of total arterial versus conventional and hybrid myocardial revascularization: A propensity score matched analysis

Purpose: To evaluate the impact of the revascularization technique (by means of conventional, total arterial or hybrid myocardial revascularization) in patients with multivessel coronary artery disease. Methods: A propensity-score analysis of patients undergoing myocardial revascularization from 1998 to 2012 was performed based on the surgical technique utilized, either total arterial (Group1, G1,n° = 89), conventional CABG(LIMA on LAD plus veins, Group2, G2,n° = 89), or hybrid revascularization (LIMA on LAD plus PTCA on non-LAD vessels, Group3, G3, n° = 89). Primary end-points were overall survival and cardiac-related death while secondary composite end-point was survival freedom from major adverse cardiac and cerebrovascular events (MACCEs) defined as myocardial infarction, cardiac death, stroke and repeated target vessel revascularization. Results: Study population was mostly affected by double-vessels disease (G1 = 2.35 vs G2 = 2.3 vs G3 = 2.4, p = 0.14) with a preserved LV function(G1 = 48% vs G2 = 49% vs G3 = 50%, p = 0.12). Hospital mortality was 0% in all groups. At a mean follow-up of 6 ± 2 years overall survival was significantly better in patients receiving total arterial myocardial revascularization (G1 = 90.4 ± 3.5% vs G2 = 82.3 ± 4.2% vs G3 = 82.1 ± 5.9%, p = 0.049) as well as freedom from MACCEs (G1 = 95.2 ± 2.4% vs G2 = 86.5 ± 4% vs G3 = 68 ± 6.9%, p = 0.001) while survival free from cardiac-related death was similar(G1 = 97.7 ± 1.6% vs G2 = 95.1 ± 2.4% vs G3 = 89.5 ± 5.4%, p = 0.08). Conversely, at 10 years follow-up only freedom from MACCEs was significantly better in patients of Group 1(G1 = 78.9 ± 8.6% vs G2 = 72.4 ± 5.7% vs G3 = 52 ± 8.7%, p < 0.001). Conclusions: Total arterial revascularization provides improved outcomes at mid and long term follow-up compared with conventional or hybrid revascularization. The latter technique is particularly associated with a significantly higher incidence of late myocardial infarction and repeat revascularization.