In-Hospital Outcomes Following Surgical Revascularization of Chronic Total Coronary Occlusions
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Morphological Coronary Analysis
2.3. Data Collection
2.4. Definitions
2.5. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Morphological Coronary Analyses and Revascularization Rates
3.3. Surgical Data
3.4. Postoperative Data and Outcomes
All (N = 1111) | Survivors (N = 1086) | Non-Survivors (N = 25) | p-Value | |
---|---|---|---|---|
CPB Time (min) | 88 [75–104] | 88 [75–104] | 90 [73–128] | 0.276 |
Cross-clamp Time (min) | 64 [54–76] | 64 [54–76] | 62 [55–99] | 0.695 |
Operative Time (min) | 210 [190–240] | 210 [190–240] | 210 [180–250] | 0.958 |
ICU Stay (days) | 0.96 [0.87;1.92] | 0.96 [0.87;1.91] | 5.77 [1.26;14.5] | <0.001 |
Postop. Stroke | 19 (1.71%) | 17 (1.57%) | 2 (8.00%) | 0.066 |
Postop. MI | 49 (4.41%) | 44 (4.05%) | 5 (20.0%) | 0.004 |
Postop. AFib | 215 (19.4%) | 212 (19.5%) | 3 (12.0%) | 0.449 |
Postop. Bleeding | 39 (3.51%) | 39 (3.59%) | 0 (0.00%) | >0.99 |
Blood Transfusion (units) | 2 [0;4] | 2 [0;4] | 10 [3;14] | <0.001 |
Plasma Transfusion | 0 [0;3] | 0 [0;3] | 3 [0;4] | 0.002 |
Postop. Dialysis | 31 (2.79%) | 13 (1.83%) | 18 (4.51%) | 0.016 |
Postop. Troponin ((maximal) g/mL) | 0.61 [0.39–1.05] | 0.61 [0.38–1.04] | 1.54 [0.80–2.04] | <0.001 |
Postop. Leukocytes (1/μL) | 12,895 [10,540;15,880] | 12,830 [10,530;15,728] | 20,435 [13,842;30,328] | <0.001 |
Postop. CRP (mg/dL) | 23.1 [18.1–27.8] | 23.1 [18.2–27.7] | 25.5 [11.8–29.1] | 0.851 |
Postop. Creatinine (mg/dL) | 1.3 [1.1–1.7] | 1.3 [1.1–1.7] | 1.5 [1.2–1.7] | 0.587 |
Hospital Stay (days) | 14 [11–18] | 14 [11–18] | 15 [6–23] | 0.959 |
Postop. GOT (U/L) | 61 [46;95] | 61 [46;91] | 206 [113;1063] | <0.001 |
Postop. GPT (U/L) | 49 [33;78] | 49 [32;77] | 236 [53.2;789] | <0.001 |
In-hospital Mortality | 2.3% | |||
Thirty-day Mortality | 2.0% |
4. Discussion
- -
- CABG achieves high CTO revascularization rates.
- -
- The surgical treatment of patients with CTOs offers very favorable early outcomes.
- -
- Older age and PAD are predictors for in-hospital mortality.
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
References
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All (N = 1111) | Survivors (N = 1086) | Non-Survivors (N = 25) | p-Value | |
---|---|---|---|---|
Age (years) | 68.0 [61.0–74.0] | 68.0 [61.0–73.8] | 76.0 [70.0–79.0] | <0.001 |
Male | 947 (85.2%) | 925 (85.2%) | 22 (88.0%) | >0.99 |
BMI (Kg/m2) | 27.7 [25.4–30.4] | 27.7 [25.4–30.5] | 27.7 [24.3–30.0] | 0.437 |
Hypertension | 924 (83.2%) | 904 (83.2%) | 20 (80.0%) | 0.595 |
Diabetes | 363 (32.7%) | 355 (32.7%) | 8 (32.0%) | >0.99 |
Smoking | 431 (38.8%) | 422 (38.9%) | 9 (36.0%) | 0.934 |
Hypercholesterolemia | 903 (81.3%) | 885 (81.5%) | 18 (72.0%) | 0.295 |
Atrial Fibrillation | 91 (8.2%) | 87 (8.0%) | 4 (16.0%) | 0.142 |
Prior MI | 330 (29.7%) | 321 (29.6%) | 9 (36.0%) | 0.634 |
PAD | 155 (14.0%) | 146 (13.4%) | 9 (36.0%) | 0.004 |
COPD | 97 (8.7%) | 94 (8.7%) | 3 (12.0%) | 0.474 |
Prior Stroke | 66 (5.9%) | 63 (5.8%) | 3 (12.0%) | 0.182 |
No. of Diseased Vessels | >0.99 | |||
Two Vessels | 58 (5.2%) | 57 (5.25%) | 1 (4.0%) | |
Three Vessels | 1053 (94.8%) | 1029 (94.8%) | 24 (96.0%) | |
LVEF < 35% | 49 (4.4%) | 46 (4.2%) | 3 (12.0%) | 0.094 |
CCS Class | N = 840 | N = 823 | N = 17 | 0.195 |
0 | 82 (9.8%) | 80 (9.72%) | 2 (11.8%) | |
1 | 41 (4.9%) | 40 (4.86%) | 1 (5.88%) | |
2 | 270 (32.1%) | 268 (32.6%) | 2 (11.8%) | |
3 | 319 (38.0%) | 312 (37.9%) | 7 (41.2%) | |
4 | 128 (15.2%) | 123 (14.9%) | 5 (29.4%) | |
NYHA | N = 840 | N = 823 | N = 17 | 0.258 |
I | 65 (7.7%) | 65 (7.9%) | (0.0%) | |
II | 362 (43.1%) | 357 (43.4%) | 5 (29.4%) | |
III | 384 (45.7%) | 373 (45.3%) | 11 (64.7%) | |
IV | 29 (3.5%) | 28 (3.4%) | 1 (5.9%) | |
N = 1111 | N = 1086 | N = 25 | ||
GFR (mL/min) | 78.8 [63.0–90.5] | 78.8 [62.9–90.6] | 79.7 [69.4–87.8] | 0.987 |
Creatinine (mg/dL) | 1.0 [0.8–1.1] | 1.0 [0.8–1.1] | 1.0 [0.8–1.0] | 0.949 |
Urea (mg/dL) | 6.0 [5.1–7.2] | 6.1 [5.1–7.2] | 5.5 [4.6–6.2] | 0.056 |
CRP (mg/dL) | 0.3 [0.2–0.8] | 0.3 [0.2–0.8] | 0.3 [0.2–0.6] | 0.900 |
Leukocytes (1/μL) | 7280 [6050;8950] | 7280 [6062;8968] | 6780 [5890;8110] | 0.314 |
Hemoglobin (g/dL) | 14.4 [13.3–15.3] | 14.4 [13.3–15.3] | 14.2 [13.0–15.2] | 0.534 |
EuroSCORE II | 1.43 [1.02;2.33] | 1.42 [1.02;2.30] | 3.33 [1.56;4.54] | 0.001 |
All (N = 1111) | Survivors (N = 1086) | Non-Survivors (N = 25) | p-Value | |
---|---|---|---|---|
No. of CTOs (mean ± SD) | 1.24 (0.45) | 1.24 (0.45) | 1.24 (0.44) | 0.989 |
No. of CTOs Bypassed (mean ± SD) | 1.08 (0.54) | 1.08 (0.54) | 1.08 (0.57) | 0.974 |
CTO Localization/Distribution * | ||||
RCA | 760 (68.4%) | 741 (68.2%) | 19 (76.0%) | 0.543 |
LCA | 1 (0.1%) | 1 (0.1%) | 0 (0.0%) | >0.99 |
LAD | 293 (26.4%) | 288 (26.5%) | 5 (20.0%) | 0.616 |
LCX | 317 (28.5%) | 311 (28.6%) | 6 (24.0%) | 0.777 |
RCA-LAD | 94 (8.5%) | 90 (8.3%) | 4 (16.0%) | 0.154 |
RCA-LCX | 115 (10.4%) | 113 (10.4%) | 2 (8.0%) | >0.99 |
LCX-LAD | 30 (2.7%) | 30 (2.8%) | 0 (0.0%) | >0.99 |
RCA-LAD-LCX | 11 (1.0%) | 11 (1.0%) | 0 (0.0%) | >0.99 |
Multiple CTOs | 251 (22.6%) | 245 (22.6%) | 6 (24.0%) | 0.098 |
Bypass to RCA-CTO | 677/760 (89.1%) | 660/741 (89.1%) | 17/19 (89.5%) | >0.99 |
Bypass to LAD-CTO | 273/293 (93.2%) | 268/288 (93.1%) | 5/5 (100%) | >0.99 |
Bypass to LCA-CTO | 1/1 (100%) | 1/1 (100%) | 0 | |
Bypass to LCX-CTO | 265/317 (83.6%) | 260/311 (83.6%) | 5/6 (83.3%) | >0.99 |
Full CTO Revascularization | 957 (86.1%) | 935 (86.1%) | 22 (88.0%) | >0.99 |
BIMA | 504 (45.4%) | 500 (46.0%) | 4 (16%) | 0.005 |
Distal Anastomosis (mean ± SD) | 3.73 (0.9) | 3.73 (0.9) | 3.80 (1.1) | 0.758 |
N = 989 | N = 968 | N = 21 | ||
CPB Time (min) | 88 [75–104] | 88 [75–104] | 90 [73–128] | 0.276 |
Cross-clamp Time (min) | 64 [54–76] | 64 [54–76] | 62 [55–99] | 0.695 |
Operative Time (min) | 210 [190–240] | 210 [190–240] | 210 [180–250] | 0.958 |
Covariates | Odds Ratio (95% Confidence Interval) | p-Value |
---|---|---|
Age | 3.44 [1.81–6.53] | <0.001 |
Gender | 0.60 [0.17–2.10] | 0.429 |
PAD | 3.32 [1.39–7.93] | 0.007 |
COPD | 0.99 [0.28–3.53] | 0.987 |
Reduced LV Function | 0.77 [0.33–1.77] | 0.537 |
BIMA | 0.48 [0.15–1.53] | 0.218 |
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Fagu, A.; Berger, T.; Pingpoh, C.; Kondov, S.; Kreibich, M.; Minners, J.; Czerny, M.; Siepe, M. In-Hospital Outcomes Following Surgical Revascularization of Chronic Total Coronary Occlusions. Medicina 2023, 59, 1967. https://doi.org/10.3390/medicina59111967
Fagu A, Berger T, Pingpoh C, Kondov S, Kreibich M, Minners J, Czerny M, Siepe M. In-Hospital Outcomes Following Surgical Revascularization of Chronic Total Coronary Occlusions. Medicina. 2023; 59(11):1967. https://doi.org/10.3390/medicina59111967
Chicago/Turabian StyleFagu, Albi, Tim Berger, Clarence Pingpoh, Stoyan Kondov, Maximilian Kreibich, Jan Minners, Martin Czerny, and Matthias Siepe. 2023. "In-Hospital Outcomes Following Surgical Revascularization of Chronic Total Coronary Occlusions" Medicina 59, no. 11: 1967. https://doi.org/10.3390/medicina59111967
APA StyleFagu, A., Berger, T., Pingpoh, C., Kondov, S., Kreibich, M., Minners, J., Czerny, M., & Siepe, M. (2023). In-Hospital Outcomes Following Surgical Revascularization of Chronic Total Coronary Occlusions. Medicina, 59(11), 1967. https://doi.org/10.3390/medicina59111967