Multiple Arterial Grafts Improve Late Survival of Patients Undergoing CABG: Analysis of 8,622 Patients With Multivessel Disease
Background—The use of left internal mammary artery (LIMA) in multivessel coronary artery disease (MVCAD) improves survival following coronary artery bypass graft surgery (CABG); however, survival benefit of multiple arterial (MultArt) grafts is debated.
Methods and Results—We reviewed 8,622 Mayo Clinic patients who had isolated primary CABG for MVCAD from 1993 to 2009. Patients were stratified by number of arterial grafts: LIMA plus saphenous veins (LIMA/SV) group (n=7,435), and MultArt group (n=1,187). Propensity score analysis matched 1,153 patients. Operative mortality was 0.8% (n=10) in MultArt and 2.1% (n=154) in LIMA/SV (P=0.005); however, not statistically different (P=0.996) in multivariate analysis, or in propensity matched groups (P=0.818). Late survival was greater for MultArt versus LIMA/SV (10-, and 15-year survival (y/s) were 84% and 71% vs 61% and 36%, respectively [P<0.001] in unmatched groups, and 83% and 70%, vs 80% and 60%, respectively [P=0.0025] in matched groups). MultArt subgroups, with bilateral internal mammary artery (BIMA)/SV (n=589) and BIMA only (n=271), had improved 15-y/s (86%, 76%, and 82%, 75% at 10-, and 15-years, [P<0.001]), and BIMA/radial artery(RA) (n=147) and LIMA/RA (n=169), had greater 10-y/s (84% and 78%, [P<0.001]) versus LIMA/SV. In multivariate analysis, MultArt grafts remained a strong independent predictor of survival (HR= 0.79, 95 % CI, 0.66-0.94, [P=0.007]).
Conclusions—In patients undergoing isolated CABG with LIMA to left anterior descending (LAD) artery, arterial grafting of the non-LAD vessels conferred a survival advantage at 15-years compared with SV grafting. It is still unproven whether these results apply to higher risk subgroups of patients.
- Received December 5, 2011.
- Accepted July 6, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited