Joshua J Hon, Arian Arjomandi Rad, Abdullah Tahir, Elisa Salagean, Marco Moscarelli, Dimitrios E Magouliotis, Roberto Casula, Thanos Athanasiou
Multivessel CE substantially increases early mortality and infarction relative to single-vessel CE. The signal is consistent across analyses but the evidence is largely retrospective and unadjusted. These data support a selective approach to CE in which the prognostic value of each target vessel is weighed against the cumulative operative cost, rather than routine extension of endarterectomy to multiple territories.
OBJECTIVES: Coronary endarterectomy (CE) extends complete revascularisation to patients with diffuse coronary disease unsuitable for conventional bypass but adds perioperative risk to coronary artery bypass grafting (CABG). Whether the number of vessels endarterectomised influences early outcomes has not been formally synthesised. We compared short-term outcomes of single-vessel and multivessel CE-CABG.
METHODS: MEDLINE, Embase, and CENTRAL were searched for studies of CE-CABG reporting outcomes stratified by single-vessel versus multivessel CE within the same cohort. The primary outcome was 30-day or in-hospital mortality. Risk ratios (RR) were pooled using DerSimonian-Laird random-effects models. Sensitivity analyses included leave-one-out analysis, Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment, and univariate meta-regression on study-level covariates. Risk of bias was assessed with ROBINS-I.
RESULTS: Nine studies (1988-2022; 7,302 patients; 4,731 single-vessel CE, 2,571 multivessel CE) met inclusion criteria. Multivessel CE was associated with higher mortality (RR, 2.59; 95% CI, 1.78-3.77), higher perioperative myocardial infarction (RR, 2.09; 95% CI, 1.67-2.62), and higher stroke (RR, 1.62; 95% CI, 1.01-2.61). Intra-aortic balloon pump use did not differ. Findings were stable on leave-one-out, HKSJ adjustment, and exclusion of pre-2000 studies. No single covariate accounted for the multivessel effect on meta-regression.
CONCLUSIONS: Multivessel CE substantially increases early mortality and infarction relative to single-vessel CE. The signal is consistent across analyses but the evidence is largely retrospective and unadjusted. These data support a selective approach to CE in which the prognostic value of each target vessel is weighed against the cumulative operative cost, rather than routine extension of endarterectomy to multiple territories.