Long-term survival after coronary bypass surgery with multiple versus single arterial grafts. (7th October 2021)

• Record Type: Journal Article
• Authors: Thuijs, Daniel J F M; Davierwala, Piroze; Milojevic, Milan; Deo, Salil V; Noack, Thilo; Kappetein, A Pieter; Serruys, Patrick W; Mohr, Friedrich-Wilhelm; Morice, Marie-Claude; Mack, Michael J; Ståhle, L Elisabeth G E; Verberkmoes, Niels J; Holmes, David R; Head, Stuart J
• Is Part Of: European journal of cardio-thoracic surgery. Volume 61:Number 4(2022)
• Page Start: 925
• Page End: 933
• Publication Date: 2021-10-07
• Subjects: SYNTAX -- Coronary artery disease -- Revascularization -- Coronary artery bypass grafting -- Multiple arterial grafts -- Survival; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezab392
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: This study sought to evaluate the long-term differences in survival between multiple arterial grafts (MAG) and single arterial grafts (SAG) in patients who underwent coronary artery bypass grafting (CABG) in the SYNTAX study. METHODS: The present analysis included the randomized and registry-treated CABG patients ( n = 1509) from the SYNTAX Extended Survival study (SYNTAXES). Patients with only venous ( n = 42) or synthetic grafts ( n = 1) were excluded. The primary end point was all-cause death at the longest follow-up. Multivariable Cox regression was used to adjust for differences in baseline characteristics. Sensitivity analysis using propensity matching with inverse probability for treatment weights was performed. RESULTS: Of the 1466 included patients, 465 (31.7%) received MAG and 1001 (68.3%) SAG. Patients receiving MAG were younger and at lower risk. At the longest follow-up of 12.6 years, all-cause death occurred in 23.6% of MAG and 40.0% of SAG patients [adjusted hazard ratio (HR) 0.74, 95% confidence interval (CI) (0.55–0.98); P = 0.038], which was confirmed by sensitivity analysis. MAG in patients with the three-vessel disease was associated with significant lower unadjusted and adjusted all-cause death at 12.6 years [adjusted HR 0.65, 95% CI (0.44–0.97); P = 0.033]. In contrast, no significance was observed after risk adjustment in patients with the left main disease, with and without diabetes, or among SYNTAX score tertiles. CONCLUSIONS: In the present post hoc analysis of all-comers patients from the SYNTAX trial, MAG resulted in markedly lower all-cause death at 12.6-year follow-up compared to a SAG strategy. Hence, this striking long-term survival benefit of MAG over SAG encourages more extensive use of multiple arterial grafting in selected patients with reasonable life expectancy. Trial registration: SYNTAXES ClinicalTrials.gov reference: NCT03417050; SYNTAX ClinicalTrials.gov reference: NCT00114972. Abstract : Whether coronary artery bypass grafting (CABG) should be performed with multiple arterial grafts (MAG) in patients requiring bypass surgery remains fiercely debated.