Abstract：
There is growing evidence in support of coronary complete revascularization (CR). Nonetheless, there is no universally accepted definition of CR in patients who undergo coronary bypass grafting surgery (CABG). We sought to investigate the outcomes of CR, defined as surgical revascularization of any territory supplied by a suitable coronary artery with ≥50% stenosis. We performed a preplanned subanalysis in the Randomized Trial of Endoscopic or Open Saphenous Vein Graft Harvesting (REGROUP) clinical trial cohort. Of 1,147 patients who underwent CABG, 810 (70.6%) received CR. The primary outcome was a composite of major adverse cardiac events (MACEs), including death from any cause, nonfatal myocardial infarction, or repeat revascularization over a median 4.7 years of follow-up. MACE occurred in 175 patients (21.6%) in the CR group and 86 patients (25.5%) in the incomplete revascularization (IR) group (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.67 to 1.13, p = 0.29). A total of 97 patients (12.0%) in the CR group and 48 patients (14.2%) in the IR group died (HR 0.93, 95% CI 0.65 to 1.32, p = 0.67); nonfatal myocardial infarction occurred in 49 patients (6.0%) in the CR group and 30 patients (8.9%) in the IR group (HR 0.76, 95% CI 0.48 to 1.2, p = 0.24), and repeat revascularization occurred in 62 patients (7.7%) in the CR group and 39 patients (11.6%) in the IR group (HR 0.64; 95% CI 0.42 to 0.95, p = 0.027). In conclusion, in patients with a great burden of co-morbidities who underwent CABG in the REGROUP trial over a median follow-up period of a median 4.7 years, CR was associated with similar MACE rates but a reduced risk of repeat revascularization. Longer-term follow-up is warranted.
摘要：
越来越多的证据支持完全冠状动脉血运重建（CR）。尽管如此，在接受CABG的患者中，没有普遍接受的CR定义。我们试图调查CR的结果，CR定义为由至少50％狭窄的合适冠状动脉提供的任何区域的手术血运重建。我们对REGROUP临床试验队列进行了预先计划的子分析。在1147名接受CABG的患者中，810（70.6%）获得CR。主要结果是主要不良心脏事件（MACE）的复合，包括任何原因的死亡,非致死性心肌梗死（MI），或在中位4.7年的随访时间内重复血运重建。CR组175例患者（21.6%）和不完全血运重建（IR）组86例患者（25.5%）发生MACE（风险比（HR）=0.87；95%置信区间[CI]0.67至1.13；p=0.29）。CR组共97例（12.0%），IR组48例（14.2%）死亡（HR=0.93；95%CI，0.65~1.32；p=0.67）；CR组49例（6.0%），IR组30例（8.9%）发生非致命性MI（HR=0.76；95%CI，0.48~1.2；p=0.24），CR组62例(7.7%)和IR组39例(11.6%)发生重复血运重建(HR=0.64;95%CI,0.42~0.95;p=0.027).总之，在REGROUP试验中，在中位4.7年的中位随访期内，在接受CABG的高合并症患者中，CR与相似的MACE发生率相关，但重复血运重建的风险降低。长期随访是必要的。
