Dataset Information

Differences in long-term survival outcomes after coronary artery bypass grafting using single vs multiple arterial grafts: a meta-analysis with reconstructed time-to-event data and subgroup analyses.

ABSTRACT:

Objective

We reviewed the available literature on patients with coronary artery disease undergoing isolated coronary artery bypass grafting (CABG) with either single (SAG) or multiple arterial grafting (MAG).

Methods

Original research studies that evaluated the long-term survival of MAG versus SAG were identified, from 1995 to 2022. The median overall survival (OS) and event-free OS were the primary endpoints. Comparison of median OS between the right internal mammary artery (RIMA) and radial artery (RA) as a second arterial conduit was the secondary endpoint. Subgroup analyses were performed regarding patients older than 70 years, with diabetes mellitus, and females. A sensitivity analysis was performed with the leave-one-out method.

Results

Forty-four studies were included in the qualitative and thirty-nine in the quantitative synthesis. After pooling data from 180 to 459 patients, the MAG group demonstrated a higher OS (HR, 0.589; 95% CI, 0.58-0.60; p < 0.0001) and event-free OS compared with the SAG group (HR, 0.828; 95% CI, 0.80-0.86; p < 0.0001). In addition, RITA was associated with superior OS compared with RA as a second arterial conduit (HR, 0.936; 95% CI, 0.89-0.98; p = 0.009). MAG was also superior to SAG in patients over 70 years, females, and patients with diabetes mellitus. Sensitivity analysis demonstrated a small-size study effect on the female subgroup analysis.

Conclusion

The present meta-analysis indicates that MAG is associated with enhanced survival outcomes compared to SAG for patients undergoing isolated CABG.

SUBMITTER: Magouliotis DE

PROVIDER: S-EPMC9886578 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

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Publications

Differences in long-term survival outcomes after coronary artery bypass grafting using single vs multiple arterial grafts: a meta-analysis with reconstructed time-to-event data and subgroup analyses.

Magouliotis Dimitrios E DE Fergadi Maria P MP Zotos Prokopis-Andreas PA Rad Arian Arjomandi AA Xanthopoulos Andrew A Bareka Metaxia M Spiliopoulos Kyriakos K Athanasiou Thanos T

General thoracic and cardiovascular surgery 20221117 2

<h4>Objective</h4>We reviewed the available literature on patients with coronary artery disease undergoing isolated coronary artery bypass grafting (CABG) with either single (SAG) or multiple arterial grafting (MAG).<h4>Methods</h4>Original research studies that evaluated the long-term survival of MAG versus SAG were identified, from 1995 to 2022. The median overall survival (OS) and event-free OS were the primary endpoints. Comparison of median OS between the right internal mammary artery (RIMA ...[more]

PMID: 36394709

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Project description:Sex-related differences in the outcome of using multiple arterial grafts during coronary artery bypass grafting (CABG) remain uncertain. To compare the outcomes of the use of multiple arterial grafts vs a single arterial graft during CABG for women and men. This statewide cohort study used data from New York's Cardiac Surgery Reporting System and New York's Vital Statistics file on 63 402 patients undergoing CABG from January 1, 2005, to December 31, 2014. Statistical analysis was performed from January 10 to August 20, 2020. Multiple arterial grafting or single arterial grafting. Mortality, acute myocardial infarction (AMI), stroke, repeated revascularization, major adverse cardiac and cerebrovascular event (composite of mortality, AMI, and stroke), and major adverse cardiac event (composite of mortality, AMI, or repeated revascularization) were compared among propensity-matched patients and stratified by the risk of long-term mortality. Of the 63 402 patients (48 155 men [76.0%]; mean [SD] age, 69.9 [10.5] years) in the study, women had worse baseline characteristics than men for most of the explored variables. Propensity matching yielded a total of 9512 male pairs and 1860 female pairs. At 7 years of follow-up, mortality was lower among men who underwent multiple arterial grafting (adjusted hazard ratio, 0.80; 95% CI, 0.73-0.87) but not women who underwent multiple arterial grafting (adjusted hazard ratio, 0.99; 95% CI, 0.84-1.15). When stratified by the estimated risk of death, the use of multiple arterial grafts was associated with better survival and a lower rate of a major adverse cardiac event among low-risk, but not high-risk, patients of both sexes, and the risk cutoff was different for men and women. This study suggests that women have a worse preoperative risk profile than men. Multiple arterial grafting is associated with better outcomes among low-risk, but not high-risk, patients, and the risk cutoffs differ between sexes. These data highlight the need for new studies on the outcome of multiple arterial grafts in women.

Project description:BackgroundData on long-term outcomes in patients with diabetes receiving multiarterial grafting (MAG) versus single-artery grafting (SAG) are limited.ObjectivesThe objective of this study is to compare long-term outcomes between MAG and SAG for coronary artery bypass graft (CABG) surgery in patients with diabetes.MethodsPatients with diabetes who underwent isolated CABG surgeries between 2000 to 2016 were identified using the New Jersey mandatory state clinical registry linked with death records and hospital discharge data (last follow-up December 31, 2019). Patients who underwent CABG for single-vessel disease, with only venous conduits, patients with previous heart surgeries, or hemodynamically unstable were excluded. Patients undergoing MAG and SAG were matched by propensity score. Cox proportional hazard models were used to investigate long-term survival and competing risk analysis was used for secondary outcomes.ResultsOf 24,944 patients, 2955 underwent MAG, and 21,989 underwent SAG CABG. Patients receiving MAG were younger, predominantly men, with a lower prevalence of hypertension, peripheral vascular disease, congestive heart failure, chronic lung disease, and renal failure. MAG was associated with lower long-term mortality compared with SAG in 2882 propensity score-matched pairs (hazard ratio [HR], 0.75; 95% CI, 0.68-0.83); lower risks of repeat revascularization (subdistribution HR, 0.86; 95% CI, 0.76-0.97); and composite outcome defined as death from any cause, stroke, postoperative myocardial infarction, and/or repeat revascularization (HR, 0.76; 95% CI, 0.71-0.82). These results were confirmed in subgroup analyses of women, men, age <70 years, and age ≥70 years patients with diabetes. MAG was also associated with lower mortality compared with SAG in patients with diabetes taking insulin in the entire cohort (Video Abstract).ConclusionsPatients with diabetes benefit from receiving MAG over SAG and demonstrated improved long-term survival, and lower hazards of secondary and composite outcomes. Coordinated efforts are needed to offer MAG to patients with diabetes.

Dataset Information

Differences in long-term survival outcomes after coronary artery bypass grafting using single vs multiple arterial grafts: a meta-analysis with reconstructed time-to-event data and subgroup analyses.

Objective

Methods

Results

Conclusion

Publications

Differences in long-term survival outcomes after coronary artery bypass grafting using single vs multiple arterial grafts: a meta-analysis with reconstructed time-to-event data and subgroup analyses.

Similar Datasets

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