Short-Term Outcomes of Coronary Endarterectomy as an Adjunct to Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis of Over 100 000 Patients

Journal article : Review

Objectives: To assess short-term outcomes of coronary artery bypass grafting (CABG) with adjunct coronary endarterectomy (CE) compared with isolated bypass grafting, and to synthesize available confounder-adjusted effect estimates. Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. MEDLINE, Embase, and CENTRAL were searched from January 2000 to June 2025. Eligible studies compared adult patients undergoing CABG with CE versus isolated CABG. Two reviewers independently screened studies, extracted data, and assessed quality. Random-effects meta-analysis was performed. The primary outcome was 30-day or in-hospital mortality. Results: Sixteen studies (119 458 patients) were included. CABG with CE was associated with higher mortality (RR 1.84, 95% CI 1.65-2.04). Pooling adjusted odds ratios from 3 studies yielded OR 1.76 (95% CI 1.55-2.00), with 2 of 3 individual estimates not reaching significance. Secondary outcomes showed increased risks of perioperative myocardial infarction (RR 1.99, 95% CI 1.29-3.07), stroke (RR 1.37, 95% CI 1.08-1.75), renal failure (RR 1.62, 95% CI 1.44-1.82), and intra-aortic balloon pump use (RR 1.96, 95% CI 1.41-2.70). Sensitivity analyses confirmed consistency across all the subgroups. Conclusions: CABG with CE is associated with higher short-term mortality and morbidity compared with isolated bypass grafting; however, confounder-adjusted analyses suggest this excess risk is partly attributable to greater baseline disease severity rather than an independent procedural effect. The scarcity of data and absence of randomized evidence preclude definitive causal conclusions. These findings provide benchmarking data for counselling when endarterectomy is necessary to achieve complete revascularization.

Authors: Hon, JJ; Arjomandi Rad, A; Egrilmezer, A; Al-Zubaidi, FI; D’Alessio, A

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Oxford University Press
• Journal: Interdisciplinary Cardiovascular and Thoracic Surgery
• Volume: 41
• Issue: 4
• Pages: ivag091
• Article number: ivag091
• Publication date: 2026-03-25
• Acceptance date: 2026-03-10
• DOI: 10.1093/icvts/ivag091
• EISSN: 2753-670X
• ISSN: 2753-670X
• Language: English
• Keywords: coronary artery disease; cardiac surgery; coronary artery bypass grafting; coronary endarterectomy
• Subtype: Review