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Published on: March 27, 2018
Differences in Long-term Outcomes After Coronary Artery Bypass Grafting Using Single vs Multiple Arterial Grafts and
Mario Gaudino1, Zaza Samadashvili2, Irbaz Hameed1,3
1Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
Insights
Multiple arterial grafts benefit men undergoing coronary artery bypass grafting (CABG), but not women. Outcomes depend on patient risk stratification, with benefits seen in low-risk individuals across sexes, but risk cutoffs differ.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Sex-related differences in outcomes following multiple arterial grafts in coronary artery bypass grafting (CABG) are not well-established.
- Women often present with worse baseline characteristics than men prior to cardiac surgery.
Purpose of the Study:
- To compare the effectiveness of multiple arterial grafts versus single arterial grafts in CABG for both men and women.
- To investigate sex-specific outcomes and the impact of risk stratification on the use of multiple arterial grafts.
Main Methods:
- A statewide cohort study analyzed data from 63,402 patients undergoing CABG in New York between 2005 and 2014.
- Propensity matching was used to create comparable groups of men and women undergoing either multiple or single arterial grafting.
- Outcomes including mortality, myocardial infarction, stroke, and adverse cardiac events were compared and stratified by long-term mortality risk.
Main Results:
- Mortality was reduced in men undergoing multiple arterial grafting (aHR, 0.80; 95% CI, 0.73-0.87), but not in women (aHR, 0.99; 95% CI, 0.84-1.15) at 7-year follow-up.
- Multiple arterial grafting was associated with better survival and fewer major adverse cardiac events in low-risk patients of both sexes.
- The risk threshold for benefiting from multiple arterial grafts differed between men and women.
Conclusions:
- Women undergoing CABG have a poorer preoperative risk profile compared to men.
- The benefits of multiple arterial grafting are evident in low-risk patients but not high-risk patients, with sex-specific risk cutoffs.
- Further research is needed to elucidate the optimal use of multiple arterial grafts in women.
Importance:
Sex-related differences in the outcome of using multiple arterial grafts during coronary artery bypass grafting (CABG) remain uncertain.
Objective:
To compare the outcomes of the use of multiple arterial grafts vs a single arterial graft during CABG for women and men.
Design, Setting, And Participants:
This statewide cohort study used data from New York's Cardiac Surgery Reporting System and New York's Vital Statistics file on 63 402 patients undergoing CABG from January 1, 2005, to December 31, 2014. Statistical analysis was performed from January 10 to August 20, 2020.
Exposures:
Multiple arterial grafting or single arterial grafting.
Main Outcomes And Measures:
Mortality, acute myocardial infarction (AMI), stroke, repeated revascularization, major adverse cardiac and cerebrovascular event (composite of mortality, AMI, and stroke), and major adverse cardiac event (composite of mortality, AMI, or repeated revascularization) were compared among propensity-matched patients and stratified by the risk of long-term mortality.
Results:
Of the 63 402 patients (48 155 men [76.0%]; mean [SD] age, 69.9 [10.5] years) in the study, women had worse baseline characteristics than men for most of the explored variables. Propensity matching yielded a total of 9512 male pairs and 1860 female pairs. At 7 years of follow-up, mortality was lower among men who underwent multiple arterial grafting (adjusted hazard ratio, 0.80; 95% CI, 0.73-0.87) but not women who underwent multiple arterial grafting (adjusted hazard ratio, 0.99; 95% CI, 0.84-1.15). When stratified by the estimated risk of death, the use of multiple arterial grafts was associated with better survival and a lower rate of a major adverse cardiac event among low-risk, but not high-risk, patients of both sexes, and the risk cutoff was different for men and women.
Conclusions And Relevance:
This study suggests that women have a worse preoperative risk profile than men. Multiple arterial grafting is associated with better outcomes among low-risk, but not high-risk, patients, and the risk cutoffs differ between sexes. These data highlight the need for new studies on the outcome of multiple arterial grafts in women.
