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Differences in long-term survival outcomes after coronary artery bypass grafting using single vs multiple arterial
Dimitrios E Magouliotis1, Maria P Fergadi2, Prokopis-Andreas Zotos3
1Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece. dimitrios.magouliotis.18@ucl.ac.uk.
Insights
Multiple arterial grafting (MAG) significantly improves long-term survival in coronary artery bypass grafting (CABG) patients compared to single arterial grafting (SAG). MAG offers better overall and event-free survival, especially for older patients, females, and those with diabetes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Research
Background:
- Coronary artery disease (CAD) management often involves coronary artery bypass grafting (CABG).
- The choice between single arterial grafting (SAG) and multiple arterial grafting (MAG) impacts long-term patient survival.
- Optimizing arterial graft selection is crucial for CABG outcomes.
Approach:
- A comprehensive literature review and meta-analysis were conducted.
- Original research studies from 1995 to 2022 comparing MAG and SAG for isolated CABG were identified.
- Long-term overall survival (OS) and event-free OS were primary endpoints, with subgroup analyses for specific patient demographics.
Key Points:
- MAG demonstrated significantly higher overall survival (HR, 0.589) and event-free survival (HR, 0.828) compared to SAG.
- The right internal mammary artery (RIMA) showed superior OS compared to the radial artery (RA) as a secondary conduit.
- MAG benefits were consistent across subgroups, including patients over 70, females, and those with diabetes.
Conclusions:
- Multiple arterial grafting (MAG) is associated with enhanced survival outcomes in isolated CABG procedures.
- The findings support the use of MAG over SAG for improved long-term prognosis in CABG patients.
- Arterial graft choice, particularly RIMA over RA, influences survival benefits.
Objective:
We reviewed the available literature on patients with coronary artery disease undergoing isolated coronary artery bypass grafting (CABG) with either single (SAG) or multiple arterial grafting (MAG).
Methods:
Original research studies that evaluated the long-term survival of MAG versus SAG were identified, from 1995 to 2022. The median overall survival (OS) and event-free OS were the primary endpoints. Comparison of median OS between the right internal mammary artery (RIMA) and radial artery (RA) as a second arterial conduit was the secondary endpoint. Subgroup analyses were performed regarding patients older than 70 years, with diabetes mellitus, and females. A sensitivity analysis was performed with the leave-one-out method.
Results:
Forty-four studies were included in the qualitative and thirty-nine in the quantitative synthesis. After pooling data from 180 to 459 patients, the MAG group demonstrated a higher OS (HR, 0.589; 95% CI, 0.58-0.60; p < 0.0001) and event-free OS compared with the SAG group (HR, 0.828; 95% CI, 0.80-0.86; p < 0.0001). In addition, RITA was associated with superior OS compared with RA as a second arterial conduit (HR, 0.936; 95% CI, 0.89-0.98; p = 0.009). MAG was also superior to SAG in patients over 70 years, females, and patients with diabetes mellitus. Sensitivity analysis demonstrated a small-size study effect on the female subgroup analysis.
Conclusion:
The present meta-analysis indicates that MAG is associated with enhanced survival outcomes compared to SAG for patients undergoing isolated CABG.
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