Joanna Chikwe1, Erick Sun2, Edward L Hannan3, Shinobu Itagaki2, Timothy Lee2, David H Adams2, Natalia N Egorova4. 1. Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Surgery, The State University of New York, Stony Brook, New York. Electronic address: joanna.chikwe@cshs.org. 2. Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York. 3. School of Public Health, University at Albany, State University of New York, Albany, New York. 4. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
Abstract
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.
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.
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: 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
Authors: Mario Gaudino; Antonino Di Franco; John H Alexander; Faisal Bakaeen; Natalia Egorova; Paul Kurlansky; Andreas Boening; Joanna Chikwe; Michelle Demetres; Philip J Devereaux; Anno Diegeler; Arnaldo Dimagli; Marcus Flather; Irbaz Hameed; Andre Lamy; Jennifer S Lawton; Wilko Reents; N Bryce Robinson; Katia Audisio; Mohamed Rahouma; Patrick W Serruys; Hironori Hara; David P Taggart; Leonard N Girardi; Stephen E Fremes; Umberto Benedetto Journal: Eur Heart J Date: 2021-12-28 Impact factor: 29.983