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Multiple arterial vs. single arterial coronary artery bypass grafting: sex-related differences in outcomes

Justin Ren1,2, Andrea Bowyer1,3,4, David H Tian1,5

  • 1Department of Surgery, University of Melbourne, 300 Grattan St, Parkville, Melbourne 3052, Australia.

European Heart Journal
|May 31, 2024
PubMed

Insights

Multiple arterial grafting improves long-term survival for both men and women undergoing coronary artery bypass grafting. This survival benefit was observed across most patient groups, indicating its effectiveness in cardiac surgery.

Area of Science:

  • Cardiovascular Surgery
  • Surgical Outcomes Research
  • Clinical Epidemiology

Background:

  • Uncertainty exists regarding sex-specific outcomes of multiple arterial grafting (MAG) versus single arterial grafting (SAG) in coronary artery bypass grafting (CABG).
  • Evaluating long-term survival differences based on grafting strategy and patient sex is crucial for optimizing CABG procedures.

Purpose of the Study:

  • To compare the long-term survival rates of patients undergoing MAG versus SAG in CABG.
  • To investigate potential sex-related differences in the survival benefits of MAG compared to SAG.

Main Methods:

  • Retrospective analysis of the Australian and New Zealand Society of Cardiothoracic Surgical Database linked to the National Death Index (2001-2020).
  • Inverse probability weighted Cox proportional hazard models were employed for sex-stratified survival comparisons.
  • Primary outcome assessed was all-cause mortality.

Main Results:

  • The study analyzed 54,275 adult patients, with 19.7% being female and 54.7% receiving MAG.
  • MAG was associated with significantly lower mortality in both men (aHR 0.82) and women (aHR 0.83) compared to SAG.
  • Survival benefits of MAG were consistent across subgroups, with the exception of female patients with left main coronary disease.

Conclusions:

  • Multiple arterial revascularization demonstrates improved long-term survival compared to single arterial grafting.
  • The survival advantage of MAG is applicable to both female and male patients undergoing CABG.
  • MAG is a beneficial strategy for enhancing long-term outcomes in a broad range of CABG patients.
Abstract

Keywords:
Arterial revascularizationCoronary artery bypass graftingFemaleInternal mammary arteryMultiple arterial graftingRadial arteryReadmissionSurvivalTotal arterial revascularization

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