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Published on: March 27, 2018
Multiple arterial coronary bypass grafting is associated with greater survival in women
Derrick Y Tam1, Rodolfo V Rocha1, Jiming Fang2
1Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Insights
Multiple arterial grafting (MAG) in coronary artery bypass grafting (CABG) improves survival and reduces adverse events in women. This approach should be considered for female patients with good life expectancy undergoing CABG for multivessel disease.
Area of Science:
- Cardiovascular Surgery
- Clinical Outcomes Research
- Arterial Grafting Techniques
Background:
- Multiple arterial grafting (MAG) in coronary artery bypass grafting (CABG) shows benefits in men, but its efficacy in women is unclear.
- Previous studies on MAG in CABG primarily included male populations, leaving a gap in understanding its impact on female patients.
Purpose of the Study:
- To compare the long-term clinical outcomes of MAG versus single arterial grafting (SAG) in women undergoing CABG for multivessel disease.
- To evaluate the impact of arterial grafting strategy on survival and major adverse cardiac and cerebrovascular events (MACCEs) specifically in female CABG patients.
Main Methods:
- Utilized linked clinical and administrative databases from Ontario, Canada (2008-2019) for women undergoing isolated, non-emergent primary CABG for multivessel disease.
- Employed 1:1 propensity score matching to create comparable groups of MAG and SAG recipients.
- Compared late mortality and MACCEs (stroke, myocardial infarction, repeat revascularization, death) using stratified log-rank tests and Cox proportional-hazards models.
Main Results:
- After matching 2446 pairs, no significant difference in 30-day mortality was observed between MAG (1.6%) and SAG (1.8%).
- Over a median follow-up of 5.0 years, MAG was associated with significantly greater survival (HR 0.85) and freedom from MACCE (HR 0.85) compared to SAG.
- The benefits of MAG were observed in women with multivessel disease undergoing CABG.
Conclusions:
- Multiple arterial grafting (MAG) is associated with improved long-term survival and reduced MACCEs in women undergoing CABG.
- MAG should be strongly considered for female patients with a good life expectancy requiring surgical revascularization for multivessel coronary artery disease.
- Arterial grafting strategy plays a crucial role in optimizing long-term outcomes for women undergoing CABG.
Objective:
Multiple arterial grafting (MAG) in coronary artery bypass grafting (CABG) is associated with higher survival and freedom from major adverse cardiac and cerebrovascular events (MACCEs) in observational studies of mostly men. It is not known whether MAG is beneficial in women. Our objectives were to compare the long-term clinical outcomes of MAG versus single arterial grafting (SAG) in women undergoing CABG for multivessel disease.
Methods:
Clinical and administrative databases for Ontario, Canada, were linked to obtain all women with angiographic evidence of left main, triple or double vessel disease undergoing isolated non-emergent primary CABG from 2008 to 2019. 1:1 propensity score matching was performed. Late mortality and MACCE (composite of stroke, myocardial infarction, repeat revascularisation and death) were compared between the matched groups with a stratified log-rank test and Cox proportional-hazards model.
Results:
2961 and 7954 women underwent CABG with MAG and SAG, respectively, for multivessel disease. Prior to propensity-score matching, compared with SAG, those who underwent MAG were younger (66.0 vs 68.9 years) and had less comorbidities. After propensity-score matching, in 2446 well-matched pairs, there was no significant difference in 30-day mortality (1.6% vs 1.8%, p=0.43) between MAG and SAG. Over a median and maximum follow-up of 5.0 and 11.0 years, respectively, MAG was associated with greater survival (HR 0.85, 95% CI 0.75 to 0.98) and freedom from MACCE (HR 0.85, 95% CI 0.76 to 0.95).
Conclusions:
MAG was associated with greater survival and freedom from MACCE and should be considered for women with good life expectancy requiring CABG.
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