Multiple arterial graft for multivessel disease tied to lower mortality at 7 years
Multiple (MAG) and single arterial coronary bypass grafts (SAG) for multivessel disease result in similar rates of mortality, as well as the composite outcome of mortality, stroke and acute myocardial infarction (MI), according to a study. However, these outcomes are lower for MAG after 7 years.
In addition, patients of higher volume MAG surgeons had lower MAG mortality.
A total of 63,402 multivessel disease patients undergoing coronary artery bypass graft surgery were identified from the New York’s cardiac registry between 1 January 2005 and 31 December 2014. Outcomes were compared for patients receiving SAGs and MAGs over a median follow-up of 6.5 years.
To reduce selection bias, patients in both arms were propensity matched using 38 baseline characteristics. Mortality was the primary endpoint, while secondary endpoints included repeat revascularization and a composite of mortality, acute MI and stroke.
Prior to matching, MAG was used in 20 percent of procedures. No mortality difference was observed at 1 year between matched MAG and SAG patients (2.4 percent vs 2.2 percent; adjusted hazard ratio [AHR], 1.11, 95 percent CI, 0.93–1.32).
However, MAG patients had a lower mortality (12.7 percent vs 14.3 percent; AHR, 0.86, 0.79–0.93), a lower composite outcome (20.2 percent vs 22.8 percent; AHR, 0.88, 0.83–0.93) and a lower repeat revascularization rate (11.7 percent vs 14.6 percent; AHR, 0.80, 0.74–0.87) at 7 years.
Subgroup analysis of MAG patients revealed that those with off-pump surgery, two-vessel disease with right coronary artery disease, recent acute MI, renal dysfunction and aged ≥70 years did not have a lower mortality at 7 years.