Anatomical versus Territorial Complete Revascularization on Long-term Survival Following Coronary Artery Bypass Grafting for Complex Coronary Disease
Presented During:
Monday, May 4, 2026: 9:00AM - 4:00PM
McCormick Place Lakeside Center
Posted Room Name:
Exhibit Hall, Poster Area
Abstract No:
P0114
Submission Type:
Abstract Submission
Authors:
YOSHINORI NAKAHARA (1), Akira Marui (2), Tomohiro Iwakura (1)
Institutions:
(1) Sakakibara Heart Institute, Tokyo, Japan, (2) Kokura Memorial Hospital, Kitakyushu, NA
Submitting Author:
YOSHINORI NAKAHARA
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Sakakibara Heart Institute
Sakakibara Heart Institute
Co-Author(s):
Akira Marui
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Kokura Memorial Hospital
Kokura Memorial Hospital
Tomohiro Iwakura
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Sakakibara Heart Institute
Sakakibara Heart Institute
Presenting Author:
YOSHINORI NAKAHARA
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Sakakibara Heart Institute
Sakakibara Heart Institute
Abstract:
Objective: Complete revascularization (CR) is a major purpose of coronary artery bypass grafting (CABG). However, an impact of "Anatomical" CR (revascularize all graftable vessels) compared with "Territorial" CR (revascularize at least 1 vessel in each coronary territory) on survival benefit has not been well elucidated.
Methods: This single-center retrospective study included 621 consecutive patients undergoing isolated CABG for three-vessel disease (2011-2017). Territorial CR was defined as at least one bypass graft to each of the three territories (LAD, LCX, and RCA). Anatomical CR was defined as achieved revascularization in all lesions ≥50% stenosis in vessels ≥1.5mm diameter according to SYNTAX trial criteria. Of 621 patients, 443 (71%) achieved anatomical CR (group A), while 178 (29%) underwent territorial CR (group T) with residual lesions in LCX (n=82, 46%), RCA (n=57, 32%), or diagonal branch (n=57, 32%). Nearly all procedures were off-pump (619/621, 99.7%) with bilateral internal thoracic arteries (598/621, 96.3%). Survival analysis used Kaplan-Meier curves and the log-rank test. Multivariate analysis employed Cox proportional hazards regression models, utilizing two approaches: (1) anatomical CR as a binary variable adjusted for key covariates, and (2) a lesion-specific analysis examining residual lesions in individual territories (diagonal branch, LCX, and RCA).
Results: Group T patients were older (69.4±9.6 vs 67.5±9.7 years, P=0.03) and received fewer grafts (4.1±0.8 vs 5.2±1.0, P<0.001). Patients receiving ≥5 grafts: 45/178 (25.3%) vs 342/443 (77.2%), P<0.001. In-hospital mortality was comparable (1/178, 0.6% vs 3/443, 0.7%, P>0.99). At median follow-up of 96 months, 10-year survival was 80.5% (group A) vs 67.9% (group T), P=0.01. Multivariate analysis showed anatomical CR trended toward improved survival (HR 0.68, 95% CI 0.47-1.01, P=0.054). Lesion-specific analysis revealed residual diagonal (HR 1.74, P=0.04) and LCX lesions (HR 1.63, P=0.048) independently predicted mortality, while residual RCA lesions had no impact (HR 0.99, P=0.98).
Conclusions: Anatomical CR demonstrated a strong, clinically relevant trend toward superior long-term survival compared with territorial CR in patients undergoing CABG for complex coronary disease. This benefit is driven by complete revascularization of LAD and LCX territories, as residual lesions in these areas independently predict mortality.
Methods: This single-center retrospective study included 621 consecutive patients undergoing isolated CABG for three-vessel disease (2011-2017). Territorial CR was defined as at least one bypass graft to each of the three territories (LAD, LCX, and RCA). Anatomical CR was defined as achieved revascularization in all lesions ≥50% stenosis in vessels ≥1.5mm diameter according to SYNTAX trial criteria. Of 621 patients, 443 (71%) achieved anatomical CR (group A), while 178 (29%) underwent territorial CR (group T) with residual lesions in LCX (n=82, 46%), RCA (n=57, 32%), or diagonal branch (n=57, 32%). Nearly all procedures were off-pump (619/621, 99.7%) with bilateral internal thoracic arteries (598/621, 96.3%). Survival analysis used Kaplan-Meier curves and the log-rank test. Multivariate analysis employed Cox proportional hazards regression models, utilizing two approaches: (1) anatomical CR as a binary variable adjusted for key covariates, and (2) a lesion-specific analysis examining residual lesions in individual territories (diagonal branch, LCX, and RCA).
Results: Group T patients were older (69.4±9.6 vs 67.5±9.7 years, P=0.03) and received fewer grafts (4.1±0.8 vs 5.2±1.0, P<0.001). Patients receiving ≥5 grafts: 45/178 (25.3%) vs 342/443 (77.2%), P<0.001. In-hospital mortality was comparable (1/178, 0.6% vs 3/443, 0.7%, P>0.99). At median follow-up of 96 months, 10-year survival was 80.5% (group A) vs 67.9% (group T), P=0.01. Multivariate analysis showed anatomical CR trended toward improved survival (HR 0.68, 95% CI 0.47-1.01, P=0.054). Lesion-specific analysis revealed residual diagonal (HR 1.74, P=0.04) and LCX lesions (HR 1.63, P=0.048) independently predicted mortality, while residual RCA lesions had no impact (HR 0.99, P=0.98).
Conclusions: Anatomical CR demonstrated a strong, clinically relevant trend toward superior long-term survival compared with territorial CR in patients undergoing CABG for complex coronary disease. This benefit is driven by complete revascularization of LAD and LCX territories, as residual lesions in these areas independently predict mortality.
ADULT CARDIAC:
Coronary Artery Disease
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