Multi-Arterial Coronary Artery Bypass Grafting Benefits Long-Term Survival

Joseph Sabik III, MD

Credit: University Hospitals

Multi-arterial coronary artery bypass grafting (CABG) was associated with superior long-term survival compared to single-arterial grafting in multivessel coronary revascularization, according to new research presented at the 60th Society of Thoracic Surgeons (STS) Annual Meeting.¹

The primary findings from the 10-year follow-up study, involving more than 1 million patients undergoing isolated CABG with ≥2 bypass grafts, showed the multi-arterial strategy may be the preferred surgical strategy for survival benefit during multivessel revascularization.

“Multiple small studies have demonstrated a survival benefit of multi-arterial grafting. We wanted to know if this survival benefit of multi-arterial grafting observed in single-center studies would translate to a large national cohort,” lead study author Joseph Sabik III, MD, University Hospitals, said in a statement.² “Using the STS Adult Cardiac Surgery Database, we were able to demonstrate that it does.”

Ongoing debate posits the best option for multivessel coronary revascularization, particularly the potential advantage of multi-arterial grafting over single-arterial grafting and saphenous vein in CABG. Sabik and colleagues aimed to compare the longitudinal survival between patients undergoing multi-arterial grafting versus single-arterial grafting.¹

All individuals undergoing isolated CABG with >2 bypass grafts in the STS Adult Cardiac Surgery Database (2008 - 2019) with links to the National Death Index were included for long-term survival analysis.Measures of risk adjustment, including inverse probability weighting and multivariable modeling, allowed for accurate comparison between the two methods. Investigators analyzed subpopulation analyses and volume thresholds to understand optimal benefits.

The study included 1,102,632 patients who underwent isolated CABG at 1108 programs. Of the study population, 100,419 (9.83%) patients underwent multi-arterial grafting, and 920,943 (90.17%) patients underwent single-arterial grafting across a median follow-up of 5.3 years. All characteristics were well-balanced following risk adjustment.

Upon analysis, multi-arterial grafting was associated with improved unadjusted (hazard ratio [HR], 0.59; 95% CI, 0.58-0.61) and adjusted (HR, 0.86; 95% CI, 0.85 - 0.88) 10-year survival, compared with single-arterial grafting. Survival advantages of multi-arterial grafting were in all patient subgroups, including stable coronary disease, acute coronary syndrome, and acute infarction.

Multi-arterial grafting showed superior survival for those with a body mass index (BMI) <40, while those with a BMI ≥40 had superior survival with single-arterial grafting. However, survival was equivalent between single-arterial and multi-arterial grafting for individuals aged ≥80 years, as well as those with severe heart failure, renal failure, peripheral vascular disease, or obesity.

These data might significantly implicate the choice clinicians and cardiac surgeons experience when deciding on the appropriate multivessel revascularization approach. In particular, Sabik and colleagues suggested multi-arterial grafting should be the surgical multivessel revascularization choice for patients with a body mass index (BMI) of <40.

“The survival benefit of multi-arterial grafting was observed in nearly all patients, except in those 80 or older and in those with comorbidities graded as severe, where multi and single-arterial grafting resulted in similar survival,” Sabik stated.² “The only patients where single arterial grafting resulted in better survival were severely obese.”

References

1. _{Multi-arterial Grafting is Associated with Superior Long-Term Survival: Ten Year Follow-up of One Million Patients Following Coronary Artery Bypass Grafting. Presented the 2024 Society of Thoracic Surgeons Annual Meeting, January 27-29, 2024.}
2. _{New research highlights superior long-term survival with multi-arterial coronary artery bypass grafting over single arterial grafting. Newswise. January 26, 2024. Accessed January 29, 2024. https://www.newswise.com/articles/new-research-highlights-superior-long-term-survival-with-multi-arterial-coronary-artery-bypass-grafting-over-single-arterial-grafting.}