Author + information
- Received July 15, 2019
- Revision received August 13, 2019
- Accepted August 14, 2019
- Published online October 28, 2019.
- Joanna Chikwe, MDa,b,∗ (, )@CedarsSinai,
- Erick Sun, BAa,
- Edward L. Hannan, PhDc,
- Shinobu Itagaki, MD, MSca,
- Timothy Lee, MDa,
- David H. Adams, MDa and
- Natalia N. Egorova, PhDd
- aDepartment of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
- bDepartment of Surgery, The State University of New York, Stony Brook, New York
- cSchool of Public Health, University at Albany, State University of New York, Albany, New York
- dDepartment of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address for correspondence:
Dr. Joanna Chikwe, Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, California 90048.
Background Benefits of multiarterial versus single-arterial coronary bypass grafting (CABG) are debated.
Objectives This study sought to compare long-term survival, morbidity, and graft patency after multiarterial versus single-arterial CABG.
Methods Mandatory clinical registries linked with discharge databases were used 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, 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 to 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 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 myocardial infarction (hazard ratio: 0.81; 95% confidence interval: 0.69 to 0.95) and lower 10-year reintervention rate (hazard ratio: 0.81; 95% confidence interval: 0.67 to 0.99).
Conclusions In contemporary practice, single-arterial CABG is used in 85% of patients and is associated with increased long-term mortality, myocardial infarction, and reintervention compared with multiarterial CABG. Multiarterial CABG is underused in contemporary surgical revascularization, and targeted referral of younger patients for multiarterial revascularization may address this practice gap.
- arterial graft
- coronary revascularization
- off-pump coronary bypass surgery
- on-pump coronary bypass surgery
The Icahn School of Medicine at Mount Sinai receives royalty payments for intellectual property from Edwards Lifesciences rand Medtronic. Dr. Chikwe has received speaker honoraria from Edwards Lifesciences. Dr. Adams has been a coprincipal investigator for trials for Medtronic and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Bernard J. Gersh, MB, ChB, DPhil, served as Guest Associate Editor for this paper.
- Received July 15, 2019.
- Revision received August 13, 2019.
- Accepted August 14, 2019.
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