Zaza Samadashvili1, Thoralf M Sundt2, Andrew Wechsler3, Joanna Chikwe4, David H Adams5, Craig R Smith6, Desmond Jordan6, Leonard Girardi7, Stephen J Lahey8, Jeffrey P Gold9, Mohammed H Ashraf10, Edward L Hannan11. 1. School of Public Health, University at Albany, State University of New York, Rensselaer, New York. 2. Cardiac Surgical Division, Massachusetts General Hospital, Boston, Massachusetts. 3. Department of Cardiothoracic Surgery, Drexel University, Philadelphia, Pennsylvania. 4. Department of Cardiothoracic Surgery, Stony Brook School of Medicine, Stony Brook, New York. 5. Department of Surgery, Mount Sinai Hospital, New York, New York. 6. Department of Surgery, Columbia-Presbyterian Medical Center, New York, New York. 7. Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York, New York. 8. Division of Cardiothoracic Surgery, University of Connecticut, Storrs, Connecticut. 9. Chancellor, University of Nebraska Medical Center, Omaha, Nebraska. 10. Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, New York. 11. School of Public Health, University at Albany, State University of New York, Rensselaer, New York. Electronic address: Edward.Hannan@health.ny.gov.
Abstract
BACKGROUND: Despite recent guideline statements, there is still wide practice variation in the use of multiple arterial grafts (MAGs) versus single arterial grafts (SAGs) for patients with multivessel disease undergoing coronary artery bypass graft surgery. This may be related to differences in findings between observational and randomized controlled studies. OBJECTIVES: This study sought to compare intermediate-term MAG and SAG outcomes with enhanced matching to reduce selection bias. METHODS: New York's cardiac registry identified 63,402 multivessel disease patients undergoing coronary artery bypass graft surgery between January 1, 2005, and December 31, 2014, to compare outcomes (median follow-up 6.5 years) for patients receiving SAGs and MAGs. SAG and MAG patients were propensity matched using 38 baseline characteristics to reduce selection bias. The primary endpoint was mortality, and secondary endpoints included repeat revascularization and a composite endpoint of mortality, acute myocardial infarction, and stroke. RESULTS: Before matching, 20% of procedures employed MAG. At 1 year, there was no mortality difference between matched MAG and SAG patients (2.4% vs. 2.2%, adjusted hazard ratio [AHR]: 1.11; 95% confidence interval [CI]: 0.93 to 1.32). At 7 years, MAG patients had lower mortality (12.7% vs. 14.3%, AHR: 0.86; 95% CI: 0.79 to 0.93), a lower composite outcome (20.2% vs. 22.8%, AHR: 0.88; 95% CI: 0.83 to 0.93), and a lower repeat revascularization rate (11.7% vs. 14.6%, AHR: 0.80; 95% CI: 0.74 to 0.87). At 7 years, the subgroups for which MAG did not have a lower mortality rate included patients with off-pump surgery, 2-vessel disease with right coronary artery disease, recent acute myocardial infarction, renal dysfunction, and patient ≥70 years of age. CONCLUSIONS: Mortality and the composite outcome were similar between MAG and SAG patients at 1 year, but lower for MAG after 7 years. Patients of higher volume MAG surgeons experienced lower MAG mortality.
BACKGROUND: Despite recent guideline statements, there is still wide practice variation in the use of multiple arterial grafts (MAGs) versus single arterial grafts (SAGs) for patients with multivessel disease undergoing coronary artery bypass graft surgery. This may be related to differences in findings between observational and randomized controlled studies. OBJECTIVES: This study sought to compare intermediate-term MAG and SAG outcomes with enhanced matching to reduce selection bias. METHODS: New York's cardiac registry identified 63,402 multivessel diseasepatients undergoing coronary artery bypass graft surgery between January 1, 2005, and December 31, 2014, to compare outcomes (median follow-up 6.5 years) for patients receiving SAGs and MAGs. SAG and MAGpatients were propensity matched using 38 baseline characteristics to reduce selection bias. The primary endpoint was mortality, and secondary endpoints included repeat revascularization and a composite endpoint of mortality, acute myocardial infarction, and stroke. RESULTS: Before matching, 20% of procedures employed MAG. At 1 year, there was no mortality difference between matched MAG and SAGpatients (2.4% vs. 2.2%, adjusted hazard ratio [AHR]: 1.11; 95% confidence interval [CI]: 0.93 to 1.32). At 7 years, MAGpatients had lower mortality (12.7% vs. 14.3%, AHR: 0.86; 95% CI: 0.79 to 0.93), a lower composite outcome (20.2% vs. 22.8%, AHR: 0.88; 95% CI: 0.83 to 0.93), and a lower repeat revascularization rate (11.7% vs. 14.6%, AHR: 0.80; 95% CI: 0.74 to 0.87). At 7 years, the subgroups for which MAG did not have a lower mortality rate included patients with off-pump surgery, 2-vessel disease with right coronary artery disease, recent acute myocardial infarction, renal dysfunction, and patient ≥70 years of age. CONCLUSIONS:Mortality and the composite outcome were similar between MAG and SAGpatients at 1 year, but lower for MAG after 7 years. Patients of higher volume MAG surgeons experienced lower MAGmortality.
Authors: Mario Gaudino; Joanna Chikwe; Volkmar Falk; Jennifer S Lawton; John D Puskas; David P Taggart Journal: Eur J Cardiothorac Surg Date: 2020-06-01 Impact factor: 4.191
Authors: N Bryce Robinson; Hillary Lia; Mohamed Rahouma; Katia Audisio; Giovanni Soletti; Michelle Demetres; Jeremy R Leonard; Stephen E Fremes; Leonard N Girardi; Mario Gaudino Journal: J Thorac Cardiovasc Surg Date: 2021-08-10 Impact factor: 5.209
Authors: Mario Gaudino; Zaza Samadashvili; Irbaz Hameed; Joanna Chikwe; Leonard N Girardi; Edward L Hannan Journal: JAMA Cardiol Date: 2020-12-23 Impact factor: 14.676