Outcomes of Second Arterial Conduits in Patients Undergoing Multivessel Coronary Artery Bypass Graft Surgery
Joanna Chikwe1, Erick Sun2, Edward L Hannan3
1Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Surgery, The State University of New York, Stony Brook, New York.
Insights
Multiarterial coronary bypass grafting (CABG) shows better long-term survival than single-arterial CABG. This study suggests multiarterial CABG is underused and could improve patient outcomes by reducing mortality and reintervention rates.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Research
Background:
- The comparative benefits of multiarterial versus single-arterial coronary artery bypass grafting (CABG) remain a subject of debate.
- Current clinical practice predominantly favors single-arterial CABG in most patients.
Purpose of the Study:
- To compare the long-term survival, morbidity, and graft patency rates between multiarterial and single-arterial CABG.
- To evaluate the contemporary utilization and outcomes of different CABG strategies.
Main Methods:
- A large cohort of 42,714 patients undergoing CABG between 2005 and 2012 was analyzed using linked clinical registries and discharge databases.
- Patients with specific conditions (single-vessel disease, no arterial conduits, emergency, reoperative, or concomitant procedures) were excluded.
- Propensity score matching was employed to compare outcomes, including survival, stroke, myocardial infarction, and repeat revascularization, with a median follow-up of 7.8 years.
Main Results:
- Multiarerial CABG was performed in 14.0% of patients and was associated with significantly lower 10-year mortality (15.1% vs. 17.3%) compared to single-arterial CABG in propensity-matched pairs.
- Patients undergoing multiarterial CABG experienced lower rates of 10-year myocardial infarction (HR: 0.81) and reintervention (HR: 0.81).
- Single-arterial CABG patients were older and had more comorbidities, receiving fewer grafts on average.
Conclusions:
- Single-arterial CABG, used in 85% of contemporary cases, is linked to increased long-term mortality, myocardial infarction, and reintervention rates compared to multiarterial CABG.
- Multiarerial CABG is underutilized in current surgical revascularization practices.
- Targeted referral of suitable patients, particularly younger individuals, for multiarterial revascularization could help bridge this practice gap and improve outcomes.
Background:
Benefits of multiarterial versus single-arterial coronary bypass grafting (CABG) are debated.
Objectives:
This study sought to compare long-term survival, morbidity, and graft patency after multiarterial versus single-arterial CABG.
Methods:
Mandatory clinical registries linked with discharge databases were used to identify baseline and operative characteristics and outcomes of 42,714 patients undergoing CABG from 2005 through 2012. Patients with single-vessel disease, without arterial conduits, or undergoing emergency, reoperative, or concomitant procedures were excluded. Survival, stroke, myocardial infarction, and repeat revascularization rates were compared using Cox modeling, and patients were matched by propensity score. Median follow-up was 7.8 years (interquartile range: 5 to 10 years); last follow-up was December 31, 2016.
Results:
Of the 26,124 patients, 3,647 (14.0%) underwent multiarterial CABG. Single-arterial CABG patients were older (mean 68 vs. 61 years; p < 0.001), had more comorbidities, and received fewer bypass grafts (3.4 vs. 3.6; p < 0.001). After adjusting for baseline differences, multiarterial CABG was associated with lower 10-year mortality compared with single-arterial CABG in 3,588 propensity-matched pairs (15.1% vs. 17.3%; p = 0.01). Multiarterial CABG was associated with lower 10-year myocardial infarction (hazard ratio: 0.81; 95% confidence interval: 0.69 to 0.95) and lower 10-year reintervention rate (hazard ratio: 0.81; 95% confidence interval: 0.67 to 0.99).
Conclusions:
In contemporary practice, single-arterial CABG is used in 85% of patients and is associated with increased long-term mortality, myocardial infarction, and reintervention compared with multiarterial CABG. Multiarterial CABG is underused in contemporary surgical revascularization, and targeted referral of younger patients for multiarterial revascularization may address this practice gap.
