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Superior Outcomes of Dual-Arterial Coronary Artery Bypass Grafting Are Maintained in the Veterans Health

Ajami Gikandi1, Dinh Tran2, Zhibao Mi2

  • 1Division of Cardiac Surgery, Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, Boston, Massachusetts; Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

The Journal of Surgical Research
|July 6, 2024
PubMed

Insights

Dual arterial grafts (DAGs) in coronary artery bypass grafting (CABG) show improved long-term outcomes compared to single arterial grafts (SAGs) in U.S. Veterans. This study suggests promoting DAG use may benefit patients undergoing CABG surgery.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
  • The use of dual arterial grafts (DAGs) versus single arterial grafts (SAGs) in CABG remains debated regarding long-term clinical benefits.
  • This study compares outcomes of DAGs (bilateral internal thoracic artery or internal thoracic artery/radial artery) versus SAGs in U.S. Veterans.

Purpose of the Study:

  • To compare the long-term clinical outcomes of dual arterial grafts (DAGs) versus single arterial grafts (SAGs) in U.S. Veterans undergoing isolated on-pump CABG.
  • To evaluate the impact of different DAG configurations (bilateral internal thoracic artery vs. internal thoracic artery/radial artery) on patient outcomes.

Main Methods:

  • A cross-sectional study was conducted using data from 25,969 U.S. Veterans undergoing isolated on-pump CABG between 2005 and 2015 at 44 VA medical centers.
  • The primary outcome was a composite of major adverse cardiac and cerebrovascular events (MACCE), including death, myocardial infarction, stroke, or repeat revascularization.
  • Follow-up was conducted over 5 years.

Main Results:

  • Dual arterial grafts (DAGs) were used in 4.9% of patients, with 66.8% being internal thoracic artery/radial artery (DAG-RA) and 33.2% bilateral internal thoracic artery (DAG-BITA).
  • Compared to SAGs, DAGs were associated with significantly lower rates of all-cause death, MACCE, and stroke.
  • DAG-BITA showed a greater benefit, with significantly lower rates of death and MACCE compared to SAGs, while DAG-RA also demonstrated a reduction in all-cause death.

Conclusions:

  • Dual arterial grafting (DAG) is associated with improved long-term MACCE outcomes compared to single arterial grafting (SAG) in the U.S. Veterans Affairs healthcare system.
  • These findings support the increased use of DAGs in CABG procedures within the VA system.
  • Promoting DAG use may enhance long-term benefits for Veterans undergoing coronary artery bypass surgery.
Abstract

Keywords:
Bilateral internal thoracic arteryCoronary artery bypass graftingMultiarterialRadial arteryVeterans

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