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Optimization in long-term survival after multiple arterial grafting in coronary artery bypass: A systematic review
Aqyl Hanif Abdillah1, Agustian Sofian2, Auzan Hakim Agustian1
1Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia.
Insights
Using multiple arterial grafts in coronary artery bypass surgery significantly reduces long-term mortality compared to single arterial grafts. This improved survival benefit was observed across all patient subgroups, supporting wider adoption of this surgical strategy.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Health Services Research
Background:
- Coronary artery bypass grafting (CABG) is standard for multi-vessel coronary artery disease.
- Multiple arterial grafts may offer better long-term outcomes than single arterial grafts.
- Wider adoption of multiple arterial grafting is limited by trial evidence and subgroup uncertainties.
Purpose of the Study:
- To compare long-term survival between multiple versus single arterial grafts in CABG.
- To evaluate the consistency of survival benefits across patient subgroups.
Main Methods:
- Systematic review and meta-analysis of 27 studies (over 1 million patients).
- Primary outcome: long-term all-cause mortality.
- Pooled hazard ratios using random-effects model; subgroup and meta-regression analyses performed.
Main Results:
- Multiple arterial grafting significantly reduced long-term mortality (approx. 20% relative reduction).
- Survival benefit was consistent across all evaluated subgroups (age, sex, diabetes, etc.).
- No patient characteristic significantly altered the benefit; no publication bias detected.
Conclusions:
- Multiple arterial grafting is associated with improved long-term survival in CABG patients.
- Findings support broader implementation of multiple arterial grafting in suitable candidates.
- Individualized surgical decision-making remains crucial.
Abstract:
IntroductionSurgical revascularization through coronary artery bypass is a widely accepted approach for treating diseases affecting multiple coronary vessels. While the standard approach uses a single arterial graft combined with vein grafts, using numerous arterial grafts may improve long-term outcomes. Although supported by observational data and guideline recommendations, the broader adoption of multiple arterial grafting has been limited due to a lack of definitive randomized trial evidence and uncertainties in specific patient subgroups.MethodsA systematic review and meta-analysis were conducted to compare long-term survival in patients receiving multiple versus single arterial grafts during coronary artery bypass surgery. Twenty-seven studies (including one randomized trial) involving more than one million patients were included. The primary outcome was long-term all-cause mortality. Hazard ratios with 95% confidence intervals were pooled using a random-effects model. Subgroup analyses were performed based on age, sex, diabetes status, graft conduit type, extent of arterial revascularization, and left ventricular function. Meta-regression examined the impact of patient characteristics.ResultsMultiple arterial grafting was associated with a significant reduction in long-term mortality compared to single arterial grafting. The pooled hazard ratio indicated an approximate 20% relative reduction in mortality. This survival benefit was consistent across all evaluated subgroups. Meta-regression did not identify any patient characteristic that significantly altered the benefit of multiple arterial grafting. No significant publication bias was detected.ConclusionMultiple arterial grafting is associated with improved long-term survival in coronary artery bypass surgery. These findings support the broader implementation of this strategy in suitable patients while emphasizing the need for individualized surgical decision-making.
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