The following is a summary of “Complete Coronary Revascularization and Outcomes in Patients Undergoing CABG: Insights from the REGROUP Trial,” published in the January 2024 issue of Cardiology by Belyayev et al.

The concept of complete coronary revascularization (CR) needs a universally accepted definition in coronary artery bypass grafting (CABG) despite growing evidence supporting its merit. To address this, researchers conducted a pre-planned subanalysis of the REGROUP clinical trial cohort, focusing on CR, defined as surgical revascularization of any territory supplied by a suitable coronary artery with at least 50% stenosis. Of the 1,147 patients undergoing CABG, 810 (70.6%) received CR. 

The primary outcome, a composite of major adverse cardiac events (MACE) encompassing death from any cause, nonfatal myocardial infarction (MI), or repeat revascularization, was evaluated over a median of 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, with a hazard ratio (HR) of 0.87 (95% CI 0.67 to 1.13; p=0.29). Mortality rates were 12.0% in the CR group and 14.2% in the IR group (HR=0.93; 95% CI, 0.65 to 1.32; p=0.67), nonfatal MI rates were 6.0% in the CR group and 8.9% in the IR group (HR=0.76; 95% CI, 0.48 to 1.2; p=0.24), and repeat revascularization rates were 7.7% in the CR group and 11.6% in the IR group (HR=0.64; 95% CI, 0.42 to 0.95; p=0.027). 

In conclusion, in the REGROUP trial, CR was associated with comparable MACE rates among patients undergoing CABG with a high comorbidity burden but exhibited a reduced risk of repeat revascularization. Nonetheless, a longer-term follow-up is imperative for comprehensive insights into the outcomes of complete coronary revascularization.

Source: sciencedirect.com/science/article/pii/S0002914924000572