Trend and factors associated with multiple arterial revascularization in coronary artery bypass grafting in the UK
Jeremy Chan1, Arnaldo Dimagli1, Tim Dong1
1Bristol Heart Institute, University of Bristol, Bristol, UK.
Insights
Multiple arterial grafting (MAG) use in UK coronary artery bypass grafting (CABG) peaked early and declined. Further research is needed to understand MAG
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Multiple arterial grafting (MAG) offers benefits over single arterial grafting in reducing major adverse cardiac events and repeat revascularization.
- Clinical guidelines recommend MAG for selected patients undergoing coronary artery bypass grafting (CABG).
- The adoption trends of MAG in isolated CABG procedures in the UK remain under investigation.
Purpose of the Study:
- To analyze the trend of multiple arterial grafting (MAG) utilization in isolated coronary artery bypass grafting (CABG) procedures within the United Kingdom.
- To compare perioperative characteristics between patients receiving single arterial grafting versus MAG.
Main Methods:
- Retrospective analysis of a prospectively collected UK national database.
- Inclusion of patients undergoing non-emergency, isolated CABG between 1996 and 2018.
- Stratification of patients into single arterial grafting and MAG groups for trend and characteristic analysis.
Main Results:
- Out of 336,321 patients, 15.56% received MAG. MAG use increased from 1996-2001, then steadily decreased, particularly radial artery use.
- MAG was more common in younger males. Propensity score matching revealed single arterial grafting was associated with more on-pump CABG, but lower in-hospital mortality and bleeding-related return to theatre.
- Single arterial grafting patients had higher rates of on-pump CABG (90% vs 69%), lower in-hospital mortality (1.1% vs 1.3%), and fewer returns to theatre for bleeding (2.5% vs 3.0%) post-matching.
Conclusions:
- Multiple arterial grafting (MAG) use in UK CABG procedures initially rose, then declined significantly from 2001 to 2018.
- The observed decrease in MAG utilization is likely multifactorial.
- Further investigation into the reasons for this trend is crucial for optimizing MAG indications in clinical practice.
Objectives:
Benefits of using multiple arterial grafting (MAG), over single arterial grafting in major adverse cardiac event rates and the need for repeat revascularization, have been widely reported. Several guidelines have recommended the use of MAG in selected patients. We report the trend of MAG in patients undergoing isolated coronary artery bypass grafting (CABG) in the UK.
Methods:
This is a retrospective analysis of a prospectively collected UK national database in patients undergoing non-emergency, isolated CABG from 1996 to 2018. Patients were divided into single arterial grafting and MAG, and trends in perioperative characteristics were analysed.
Results:
A total of 336 321 patients were included, of whom 284 003 (84.44%) received single arterial grafting and 52 318 (15.56%) received MAG. The use of MAG after an initial increase from 1996 to 2001, steadily decreased thereafter, particularly in the use of radial artery. MAG was likely to be performed in younger patients [66.72 (standard deviation: 9.22) vs 62.30 (standard deviation: 10.06), P < 0.001] and males (85% vs 81%, P < 0.001). After propensity score matching, the single arterial grafting group was more likely to undergo on-pump CABG (90% vs 69%, P < 0.001), experienced a lower in-hospital mortality (1.1% vs 1.3%, P < 0.001) and incidence of return to theatre for bleeding (2.5% vs 3.0%, P < 0.001).
Conclusions:
Our data show that the use of MAG in CABG in the UK after an initial increase from 1996 to 2001 steadily decreased thereafter until 2018. This is likely to be multifactorial and a better understanding of the main causes may contribute to establishing the best indication for MAG in everyday clinical practice.
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