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Outcomes of Multiarterial vs. Single-Arterial CABG
Study Questions:
What is the long-term survival, morbidity, and graft patency after multiarterial versus single-arterial coronary bypass grafting (CABG)?
Methods:
The investigators used mandatory clinical registries linked with discharge databases to identify baseline and operative characteristics and outcomes of 42,714 patients undergoing CABG from 2005 through 2012. Patients with single-vessel disease, without arterial conduits, or undergoing emergency, reoperative, or concomitant procedures were excluded. Survival, stroke, myocardial infarction (MI), and repeat revascularization rates were compared using Cox modeling, and patients were matched by propensity score. Median follow-up was 7.8 years (interquartile range, 5-10 years); last follow-up was December 31, 2016.
Results:
Of the 26,124 patients, 3,647 (14.0%) underwent multiarterial CABG. Single-arterial CABG patients were older (mean age 68 vs. 61 years; p < 0.001), had more comorbidities, and received fewer bypass grafts (3.4 vs. 3.6; p < 0.001). After adjusting for baseline differences, multiarterial CABG was associated with lower 10-year mortality compared with single-arterial CABG in 3,588 propensity-matched pairs (15.1% vs. 17.3%; p = 0.01). Multiarterial CABG was associated with lower 10-year MI (hazard ratio, 0.81; 95% confidence interval, 0.69-0.95) and lower 10-year reintervention rate (hazard ratio, 0.81; 95% confidence interval, 0.67-0.99).
Conclusions:
The authors concluded that single-arterial CABG is associated with increased long-term mortality, MI, and reintervention compared with multiarterial CABG.
Perspective:
This contemporary multicenter cohort study of patients undergoing CABG reports that the long-term risks of MI and death associated with single-arterial CABG, which is used in 85% of patients, were higher than those associated with multiarterial CABG. Furthermore, single-arterial CABG was also associated with increased rates of repeat revascularization, including both repeat CABG and percutaneous coronary intervention, compared with multiarterial revascularization. These data have implications for the optimal choice of procedure for a substantial proportion of patients undergoing surgical revascularization, and indicate that multiarterial revascularization is greatly underused in contemporary practice. There appears to be a need for targeted strategies to increase use of multiarterial surgical revascularization during CABG.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Aortic Surgery, Cardiac Surgery and Arrhythmias
Keywords: Cardiac Surgical Procedures, Comorbidity, Coronary Artery Bypass, Coronary Artery Bypass, Off-Pump, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Percutaneous Coronary Intervention, Secondary Prevention, Stroke, Treatment Outcome
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