Impact of multi-arterial revascularization on long-term major adverse cardiovascular events after coronary bypass in 23,798 patients.

Overview

abstract

BACKGROUND: This study evaluated the association between multiarterial versus single arterial bypass grafting (SAG) and all-cause mortality and major adverse cardiocerebrovascular events (MACCE), overall and across different patient subgroups from a Middle-Eastern nation. METHODS: This single-center retrospective cohort study included 23798 patients. MAG and SAG groups were balanced using inverse probability weighting (IPW). Associations between MAG and outcomes were assessed using Cox regression. A series of covariate-adjusted Cox models were conducted to evaluate the effect of MAG on outcomes at different levels of independent variables, including age, sex, and cardiovascular risk factors. RESULTS: In the study population (73.9% male, 65.11±9.94 years), 986 patients (4.1%) underwent MAG. Compared to the SAG group, MAG had lower crude mortality (14.1% vs. 21.6%) and MACCE (28.8% vs. 34.7%) rates during follow-up (9.23 [9.13-9.33] years). Although MAG was significantly associated with reduced risk of study outcomes at the univariate level, these associations disappeared after matching (all-cause mortality: IPW-Hazard ratio: 0.90 [95% confidence interval[CI]:0.67-1.22]; MACCE: IPW-Hazard ratio: 0.94 [95%CI:0.76-1.15]). However, covariate-adjusted models indicated that MAG was associated with a significantly reduced risk of adverse events, particularly MACCE, in men, younger patients, and those without risk factors. CONCLUSIONS: MAG was not associated with improved post-surgery outcomes among the total CABG population. Our findings, however, should be interpreted in the context of a relatively low total institutional MAG burden. Choosing a second arterial conduit over saphenous vein grafts in specific patient subgroups might be reasonable. This hypothesis-generating finding should be investigated in future clinical trials in these patients.