Long-Term Survival of Multiple Versus Single Arterial Coronary Bypass Grafting in Elderly Patients

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Multiple arterial grafting (MAG) is an underutilized coronary artery bypass grafting (CABG) technique, particularly in older populations.
• Evidence comparing MAG to single arterial grafting (SAG) regarding age-specific outcomes is limited.

Purpose of the Study:

• To investigate the association between patient age and the comparative outcomes of MAG versus SAG.
• To evaluate the efficacy of MAG in elderly patients undergoing primary isolated CABG.

Main Methods:

• Utilized data from the Australian and New Zealand national registry for adult patients undergoing primary isolated CABG.
• Employed propensity score matching to create comparable groups for MAG and SAG.
• Assessed all-cause late mortality, 30-day mortality, and 30-day hospital readmission as primary and secondary outcomes.

Main Results:

• A total of 69,624 patients were included, with propensity score matching creating 16,882 pairs (<70 years) and 10,921 pairs (≥70 years).
• MAG was associated with significantly reduced all-cause late mortality compared to SAG in both younger (HR 0.73) and elderly (HR 0.84) patient subgroups.
• No significant difference was found in 30-day mortality or readmission rates between MAG and SAG.

Conclusions:

• Multiple arterial grafting (MAG) provides a significant survival advantage over single arterial grafting (SAG) for coronary artery bypass surgery.
• This survival benefit of MAG is consistent across both younger and elderly patient populations.
• MAG should be considered a viable and beneficial revascularization strategy for a broader range of CABG patients, including the elderly.