Adjunct Coronary Endarterectomy in CABG: Risk Stratification and Mid-Term Outcomes

BACKGROUND: Complete revascularization in diffuse coronary artery disease (CAD) is challenging when target vessels are small and circumferentially diseased. Coronary endarterectomy (CE) can enable reconstruction where a standard distal anastomosis is not feasible, but its impact remains debated. This study aimed to evaluate the impact of concomitant CE with CABG on the mid-term outcomes and explored the potential risk factors for adverse events. METHODS: Single-centre retrospective cohort (2017-2022) of patients undergoing CABG with or without CE (n=406; CE n=97, CABG-only n=309). The prespecified primary endpoint was major adverse cardiovascular events (MACE: all-cause mortality or myocardial infarction) assessed in-hospital/30 days and up to 72 months. CE-subgroup risk modelling used Firth-penalised logistic regression. Effects were summarized as odds ratio (95% CIs); time-to-event analyses used Kaplan-Meier. RESULTS: Early peri-operative MI and in-hospital mortality did not differ significantly between groups. Over 72 months, overall survival was similar (log-rank P=0.289). Within the CE cohort, mid-term MI (1.0%) and stroke (2.1%) were infrequent. In multivariable CE-subgroup modelling, female sex, renal impairment, peripheral vascular disease, and age ≥65 were independently associated with complications; with female sex demonstrating the strongest association. CONCLUSIONS: Selective CE with CABG yielded comparable early and mid-term outcomes to CABG-only, with low mid-term complication rates. Risk was concentrated among women, patients with renal impairment or peripheral vascular disease, and those ≥65 years, supporting heightened peri-operative vigilance and tailored follow-up in these subgroups.