Which CABG Method Is Safer, More Effective?

Multiple arterial grafting (MAG) was associated with more benefits and fewer adverse events compared with the standard use of left internal thoracic artery (LITA) supplemented by saphenous vein grafts (SVG), according to a recent study.

The population-based observational study included 20,076 patients with triple-vessel or left-main disease who underwent primary isolated coronary artery bypass grafting. A total of 5580 participants underwent MAG (mean age 60 years) and 14,496 underwent LITA with SVG (mean age 68 years). Mortality, repeated revascularization, myocardial infarction, heart failure, and stroke were assessed as the primary outcomes. The researchers used propensity-score analyses and multivariable Cox regression to analyze the relationship between the primary outcomes and MAG and LITA with SVG.
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The median follow-up times were 9.1 years for those who underwent MAG and 8.1 years for those who underwent LITA with SVG.

MAG was associated with reduced mortality rates and repeated revascularizations rates compared with LITA with SVG over 15 years of follow-up, and with reduced incidences of myocardial infarction and heart failure compared with LITA with SVG over 7 years of follow-up.

The results persisted among patient subgroups, including those with diabetes, obesity, moderately impaired ejection fraction, chronic obstructive pulmonary disease, peripheral vascular disease, and renal disease.

In addition, MAG was not associated with increased morbidity or mortality rates at 30 days among all patients and within subgroups.

“Compared with LITA+SVG, MAG is associated with reduced mortality, repeated revascularization, myocardial infarction, and heart failure among patients with multivessel disease who are undergoing coronary artery bypass grafting without increased mortality or other adverse events at 30 days,” the researchers concluded. “The long-term benefits consistently observed across multiple outcomes and subgroups support the consideration of MAG for a broader spectrum of patients who are undergoing coronary artery bypass grafting in routine practice.”

—Melissa Weiss

Reference:

Pu A, Ding L, Shin J, et al. Long-term outcomes of multiple arterial coronary artery bypass grafting: a population-based study of patients in British Columbia, Canada [published online October 11, 2017]. JAMA Cardiol. doi:10.1001/jamacardio.2017.3705.