AUTHOR=Pasierski Michal , Staromłyński Jakub , Finke Janina , Litwinowicz Radoslaw , Filip Grzegorz , Kowalówka Adam , Wańha Wojciech , Kołodziejczak Michalina , Piekuś-Słomka Natalia , Łoś Andrzej , Stefaniak Sebastian , Wojakowski Wojciech , Jemielity Marek , Rogowski Jan , Deja Marek , Jagielak Dariusz , Bartus Krzysztof , Mariani Silvia , Li Tong , Matteucci Matteo , Ronco Daniele , Jiritano Federica , Fina Dario , Martucci Gennaro , Meani Paolo , Raffa Giuseppe Maria , Słomka Artur , Malvidni Pietro Giorgio , Lorusso Roberto , Zembala Michal , Suwalski Piotr , Kowalewski Mariusz TITLE=Clinical Insights to Complete and Incomplete Surgical Revascularization in Atrial Fibrillation and Multivessel Coronary Disease JOURNAL=Frontiers in Cardiovascular Medicine VOLUME=Volume 9 - 2022 YEAR=2022 URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.910811 DOI=10.3389/fcvm.2022.910811 ISSN=2297-055X ABSTRACT=Objectives

Although endorsed by international guidelines, complete revascularization (CR) with Coronary Artery Bypass Grafting (CABG) remains underused. In higher-risk patients such as those with pre-operative atrial fibrillation (AF), the effects of CR are not well studied.

Methods

We analyzed patients’ data from the HEIST (HEart surgery In AF and Supraventricular Tachycardia) registry. Between 2012 and 2020 we identified 4770 patients with pre-operative AF and multivessel coronary artery disease who underwent isolated CABG. We divided the cohort according to the completeness of the revascularization and used propensity score matching (PSM) to minimize differences between baseline characteristics. The primary endpoint was all-cause mortality.

Results

Median follow-up was 4.7 years [interquartile range (IQR) 2.3–6.9]. PSM resulted in 1,009 pairs of complete and incomplete revascularization. Number of distal anastomoses varied, accounting for 3.0 + –0.6 vs. 1.7 + –0.6, respectively. Although early (< 24 h) and 30-day post-operative mortalities were not statistically different between non-CR and CR patients [Odds Ratio (OR) and 95% Confidence Intervals (CIs): 1.34 (0.46–3.86); P = 0.593, Hazard Ratio (HR) and 95% CIs: 0.88 (0.59–1.32); P = 0.542, respectively] the long term mortality was nearly 20% lower in the CR cohort [HR (95% CIs) 0.83 (0.71–0.96); P = 0.011]. This benefit was sustained throughout subgroup analyses, yet most accentuated in low-risk patients (younger i.e., < 70 year old, with a EuroSCORE II < 2%, non-diabetic) and when off-pump CABG was performed.

Conclusion

Complete revascularization in patients with pre-operative AF is safe and associated with improved survival. Particular survival benefit with CR was observed in low-risk patients undergoing off-pump CABG.