Three Arterial Grafts Improve Late Survival: A Meta-Analysis of Propensity Matched Studies
Background—There is little evidence whether a third arterial graft provides superior outcomes in comparison to the use of two arterial grafts in patients undergoing coronary artery bypass grafting (CABG). A meta-analysis of all the propensity score matched (PSM) observational studies comparing the long-term outcomes of CABG with the use of two (2-ART) vs. three arterial (3-ART) grafts was performed.
Methods—A literature search was conducted using MEDLINE, EMBASE, and Web of Science to identify relevant articles. Long-term mortality in the PSM populations was the primary endpoint. Secondary endpoints were in-hospital/30-day mortality for the PSM populations and long-term mortality for the unmatched populations. In the matched population, time-to-event outcome for long-term mortality was extracted as hazard ratios (HRs) along with their variance. Statistical pooling of survival (time-to-event) was performed according to a random effect model, computing risk estimates with 95% confidence intervals (CI).
Results—A total of 8 PSM studies reporting on 10,287 matched patients (2-ART: 5346; 3-ART: 4941) were selected for final comparison. The mean follow-up time ranged from 37.2 to 196.8 months. The use of three arterial grafts was not statistically associated with early mortality (HR, 0.93; 95% CI, 0.71-1.22; p= .62). The use of three arterial grafts was associated with statistically significantly lower hazard for late death (HR, 0.8; 95% CI, 0.75-0.87; p< .001), irrespective of sex and diabetic status. This result was qualitatively similar in the unmatched population (HR, 0.57; 95% CI, 0.33-0.98; p= .04).
Conclusions—The use of a third arterial conduit in CABG patients is not associated with higher operative risk and is associated with superior long-term survival, irrespective of sex and diabetic status.
- total arterial revascularization
- bilateral internal thoracic arteries
- radial artery
- coronary artery bypass graft
- coronary artery bypass graft surgery
- Received September 12, 2016.
- Revision received December 21, 2016.
- Accepted January 17, 2017.