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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Multiple versus single arterial grafting in coronary artery bypass grafting: A meta-analysis of randomized controlled
Francisca A Saraiva1, João P Leite-Moreira1, António S Barros1
1Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal.
Insights
Multiple arterial grafting (MAG) in coronary artery bypass grafting (CABG) improves survival and reduces major adverse cardiac and cerebrovascular events (MACCEs). While bilateral internal mammary artery (BIMA) configurations increase sternal wound complications, overall MAG offers significant long-term benefits.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Research
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
- Graft selection, specifically arterial versus venous conduits, impacts long-term outcomes.
- The use of multiple arterial grafts (MAG) is increasingly explored for improved patency and survival.
Purpose of the Study:
- To compare survival and major adverse cardiac and cerebrovascular events (MACCEs) between multiple arterial grafts (MAG) and single arterial graft (SAG) in CABG.
- To evaluate early and long-term outcomes associated with MAG versus SAG.
- To assess the specific risk of sternal wound complications (SWC) with different MAG configurations.
Main Methods:
- Meta-analysis of randomized controlled trials (RCTs) and propensity score (PS) studies.
- Literature search of MEDLINE, Web of Science, and Cochrane Library (1960-2018).
- Analysis of survival (≥1 year follow-up), MACCEs, and early outcomes using hazard ratios and odds ratios with random-effect models.
Main Results:
- MAG was associated with lower early mortality (OR: 0.82), long-term mortality (HR: 0.76), and MACCEs (HR: 0.85) compared to SAG.
- No significant increase in overall MACCEs was observed with MAG.
- An increased risk of sternal wound complications (SWC) was noted specifically with the bilateral internal mammary artery (BIMA) configuration (OR: 1.96).
Conclusions:
- Multiple arterial grafting (MAG) significantly improves early and long-term survival and reduces MACCEs in CABG patients.
- The bilateral internal mammary artery (BIMA) configuration for MAG is associated with a higher risk of SWC.
- Despite the risk of SWC with BIMA, MAG remains a beneficial strategy for CABG, balancing risks and benefits.
Objectives:
We conducted a meta-analysis of randomized controlled trials (RCTs) and propensity score (PS) studies comparing survival and major adverse cardiac and cerebrovascular events (MACCEs) of patients who underwent coronary artery bypass grafting (CABG) with multiple (MAG) versus single arterial grafting (SAG).
Methods:
MEDLINE, Web of Science and Cochrane Library were used to find relevant literature (1960-2018). Survival at a follow-up ≥1 year, MACCEs and early outcomes were evaluated. Time-to-event outcomes were collected through hazard ratio (HR) along with their variance, and the other endpoints using frequencies from matched sample or adjusted odds ratios. Random effect models were used to compute combined statistical measures and 95% confidence intervals (CI) through generic inverse variance method (time-to-event) or Mantel-Haenszel method (binary events).
Results:
Twenty-nine PS cohorts and 8 RCTs comprising 122,832 patients (52,178 MAG and 70,654 SAG) were included in this meta-analysis. MAG was associated with lower early mortality (OR: 0.82, 95%CI: 0.71-0.95, p = .007), long-term mortality (HR: 0.76, 95%CI: 0.73-0.78, p < .001) and MACCEs (HR: 0.85, 95%CI: 0.79-0.91, p < .001). Increased risk of sternal wound complications (SWC) was only observed when the bilateral internal mammary artery configuration was used for MAG (OR MAG BIMA: 1.96, 95%CI: 1.37-2.81, p < .001).
Conclusion:
Although the BIMA configuration increases the risk of SWC, MAG improves both early and long-term survival as well as MACCEs in CABG.
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