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Total arterial coronary bypass graft surgery is associated with better long-term survival in patients with multivessel coronary artery disease: a systematic review with meta-analysis
Rayol, Sérgio C; Eynde, Jef Van den; Cavalcanti, Luiz Rafael P; Escorel Neto, Antonio Carlos; Rad, Arian Arjomandi; Amabile, Andrea; Botelho Filho, Wilson; Ruhparwar, Arjang; Zhigalov, Konstantin; Weymann, Alexander; Sobral Filho, Dario Celestino; Sá, Michel Pompeu B O.
  • Rayol, Sérgio C; Pronto-Socorro Cardiológico de Pernambuco. Division of Cardiovascular Surgery. Recife. BR
  • Eynde, Jef Van den; University Hospitals Leuven. Research Unit of Cardiac Surgery. Department of Cardiovascular Diseases. Leuven. BE
  • Cavalcanti, Luiz Rafael P; Pronto-Socorro Cardiológico de Pernambuco. Division of Cardiovascular Surgery. Recife. BR
  • Escorel Neto, Antonio Carlos; Pronto-Socorro Cardiológico de Pernambuco. Division of Cardiovascular Surgery. Recife. BR
  • Rad, Arian Arjomandi; Imperial College London School of Medicine. London. GB
  • Amabile, Andrea; University of Chicago Medicine. Department of Cardiac Surgery. Chicago. US
  • Botelho Filho, Wilson; Universidade de São Paulo. Instituto do Coração. São Paulo. BR
  • Ruhparwar, Arjang; University Duisburg-Essen. University Hospital of Essen. West German Heart and Vascular Center Essen. Essen. DE
  • Zhigalov, Konstantin; University Duisburg-Essen. University Hospital of Essen. West German Heart and Vascular Center Essen. Essen. DE
  • Weymann, Alexander; University Duisburg-Essen. University Hospital of Essen. West German Heart and Vascular Center Essen. Essen. DE
  • Sobral Filho, Dario Celestino; University of Pernambuco. Recife. BR
  • Sá, Michel Pompeu B O; Pronto-Socorro Cardiológico de Pernambuco. Division of Cardiovascular Surgery. Recife. BR
Rev. bras. cir. cardiovasc ; 36(1): 78-85, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1155798
ABSTRACT
Abstract

Introduction:

The benefit of total arterial revascularization (TAR) in coronary artery bypass grafting (CABG) remains a controversial issue. This study sought to evaluate whether there is any difference on the long-term results of TAR and non-TAR CABG patients.

Methods:

The Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL/CCTR), Clinical Trials.gov, Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), and Google Scholar databases were searched for studies published by October 2020. Randomized clinical trials and observational studies with propensity score matching comparing TAR versus non-TAR CABG were included. Random-effects meta-analysis was performed. The current barriers to implementation of TAR in clinical practice and measures that can be used to optimize outcomes were reviewed.

Results:

Fourteen publications (from 2012 to 2020) involving a total of 22,746 patients (TAR 8,941 patients; non-TAR 13,805 patients) were included. The pooled hazard ratio (HR) for long-term mortality (over 10 years) was lower in the TAR group than in the non-TAR group (random effect model HR 0.676, 95% confidence interval 0.586-0.779, P<0.001). There was evidence of low heterogeneity of treatment effect among the studies for mortality, and none of the studies had a particular impact on the summary result. The result was not influenced by age, sex, or comorbidities. We identified low risk of publication bias related to this outcome.

Conclusion:

This review found that TAR presents the best long-term results in patients who undergo CABG. Given that many patients are likely to benefit from TAR, its use should be encouraged.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Coronary Artery Disease / Percutaneous Coronary Intervention Type of study: Controlled clinical trial / Observational study / Prognostic study / Risk factors / Systematic reviews Limits: Humans Language: English Journal: Rev. bras. cir. cardiovasc Journal subject: Cardiology / General Surgery Year: 2021 Type: Article Affiliation country: Belgium / Brazil / Germany / United States / United kingdom Institution/Affiliation country: Imperial College London School of Medicine/GB / Pronto-Socorro Cardiológico de Pernambuco/BR / Universidade de São Paulo/BR / University Duisburg-Essen/DE / University Hospitals Leuven/BE / University of Chicago Medicine/US / University of Pernambuco/BR

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Full text: Available Index: LILACS (Americas) Main subject: Coronary Artery Disease / Percutaneous Coronary Intervention Type of study: Controlled clinical trial / Observational study / Prognostic study / Risk factors / Systematic reviews Limits: Humans Language: English Journal: Rev. bras. cir. cardiovasc Journal subject: Cardiology / General Surgery Year: 2021 Type: Article Affiliation country: Belgium / Brazil / Germany / United States / United kingdom Institution/Affiliation country: Imperial College London School of Medicine/GB / Pronto-Socorro Cardiológico de Pernambuco/BR / Universidade de São Paulo/BR / University Duisburg-Essen/DE / University Hospitals Leuven/BE / University of Chicago Medicine/US / University of Pernambuco/BR