Clinical event rate in patients with and without left main disease undergoing isolated coronary artery bypass grafting: results from the European DuraGraft Registry
Authors: Caliskan Etem , Misfeld Martin , Sandner Sigrid , Böning Andreas , Aramendi Jose , Salzberg Sacha P , Choi Yeong-Hoon , Perrault Louis P , Tekin Ilker , Cuerpo Gregorio P , Lopez-Menendez Jose , Weltert Luca P , Böhm Johannes , Krane Markus , González-Santos José M , Tellez Juan-Carlos , Holubec Tomas , Ferrari Enrico , Emmert Maximilian Y ,   European DuraGraft Registry investigators, Huenges Katharina , Grubitzsch Herko , Bakthiary Farhad , Kempfert Jörg , Penkalla Adam J , Danner Bernhard C , Jebran Fawad A , Benstoem Carina , Goetzenich Andreas , Stoppe Christian , Kuhn Elmar W , Liakopoulos Oliver J , Brose Stefan , Matschke Klaus , Veerasingam Dave , Doddakula Kishore , Wolf Lorenzo Guerrieri , Serraino Giuseppe Filiberto , Mastroroberto Pasquale , Lamascese Nicola , Sella Massimo , Fajardo-Rodriguez Edmundo R , Crespo Alejandro , Gonález Angel L Fernandez , Pedraz Alvaro , Arnáiz-García Elena , Carvajal Ignacio Muñoz , Fontaine Adrian J , Rodríguez José Ramón González , Mera José Antonio Corrales , Martinez Paloma , Blazquez Jose Antonio , Ramirez Bella , Adsuar-Gomez Alejandro , Borrego-Dominguez Jose M , Muñoz-Guijosa Christian , Badía-Gamarra Sara , Sádaba Rafael , Gainza Alicia , Castellá Manuel , Laguna Gregorio , Gualis Javier A , Demertzis Stefanos , Grünenfelder Jürg , Bauernschmitt Robert , Bose Amal K , Al-Attar Nawwar , Gradinariu George 
Published: August 2022

Abstract

OBJECTIVES
Left main coronary artery disease (LMCAD) is considered an independent risk factor for clinical events after coronary artery bypass grafting (CABG). We have conducted a subgroup analysis of the multicentre European DuraGraft Registry to investigate clinical event rates at 1 year in patients with and without LMCAD undergoing isolated CABG in contemporary practice.

METHODS
Patients undergoing isolated CABG were selected. The primary end point was the incidence of a major adverse cardiac event (MACE) defined as the composite of death, myocardial infarction (MI) or repeat revascularization (RR) at 1 year. The secondary end point was major adverse cardiac and cerebrovascular events (MACCE) defined as MACE plus stroke. Propensity score matching was performed to balance for differences in baseline characteristics.

RESULTS
LMCAD was present in 1033 (41.2%) and absent in 1477 (58.8%) patients. At 1 year, the MACE rate was higher for LMCAD patients (8.2% vs 5.1%, P = 0.002) driven by higher rates of death (5.4% vs 3.4%, P = 0.016), MI (3.0% vs 1.3%, P = 0.002) and numerically higher rates of RR (2.8% vs 1.8%, P = 0.13). The incidence of MACCE was 8.8% vs 6.6%, P = 0.043, with a stroke rate of 1.0% and 2.4%, P = 0.011, for the LMCAD and non-LMCAD groups, respectively. After propensity score matching, the MACE rate was 8.0% vs 5.2%, P = 0.015. The incidence of death was 5.1% vs 3.7%, P = 0.10, MI 3.0% vs 1.4%, P = 0.020, and RR was 2.7% vs 1.6%, P = 0.090, for the LMCAD and non-LMCAD groups, respectively. Less strokes occurred in LMCAD patients (1.0% vs 2.4%, P = 0.017). The MACCE rate was not different, 8.5% vs 6.7%, P = 0.12.

CONCLUSIONS
In this large registry, LMCAD was demonstrated to be an independent risk factor for MACE after isolated CABG. Conversely, the risk of stroke was lower in LMCAD patients.

Clinical trial registration number
ClinicalTrials.gov NCT02922088.