THE IMPORTANCE OF COMPLETENESS OF REVASCULARIZATION DURING LONG-TERM FOLLOW-UP AFTER CORONARY-ARTERY OPERATIONS

Completeness of revascularization after coronary artery bypass operati on has been shown to improve short- and medium-term-outcome, The purpo se of this study was to assess the independent contribution of complet eness of revascularization to long-term outcome, A total of 2057 patie nts with multivessel disease with complete revascularization and 803 w ith incomplete revascularization, mean age 57 +/- 9 years, was studied , The patient groups were similar except for more prior myocardial inf arctions, worse left. ventricular function, and more three-vessel dise ase in the incomplete revascularization group, Complications of periop erative infarction and stroke were not different between those having complete versus incomplete revascularization, The hospital death rate for patients having complete revascularization during the period of st udy was 0.7% versus 1.5% for those having incomplete revascularization (p = 0.06). Length of hospital stay for the two groups of patients al so was not different, At late follow-up (mean 11.7 years for complete and 10.8 years for incomplete) patients who had incomplete revasculari zation had a significantly higher prevalence of recurrent angina, Mult ivariate analysis demonstrated the strongest predictors of incomplete revascularization to be number of vessels diseased and left ventricula r function (ejection fraction). The multivariate correlates of surviva l were older age, left ventricular dysfunction, and completeness of re vascularization, Completeness of revascularization correlated with imp roved overall patient survival, as well as survival in patients with n ormal left ventricular function. Furthermore, the curves continued to separate over time, such that the difference was greater at 8 years th an at 4 years, although by 12 years the curves started to converge.