Multiple arterial grafts improve late survival of patients undergoing coronary artery bypass graft surgery: Analysis of 8622 patients with multivessel disease

Chaim Locker, Hartzell V Schaff, Joseph A. Dearani, Lyle D. Joyce, Soon J. Park, Harold M. Burkhart, Rakesh M. Suri, Kevin L. Greason, John M. Stulak, Zhuo Li, Richard C. Daly

Research output: Contribution to journalArticle

135 Citations (Scopus)

Abstract

Background-Use of the left internal mammary artery (LIMA) in multivessel coronary artery disease improves survival after coronary artery bypass graft surgery; however, the survival benefit of multiple arterial (MultArt) grafts is debated. Methods and Results-We reviewed 8622 Mayo Clinic patients who had isolated primary coronary artery bypass graft surgery for multivessel coronary artery disease from 1993 to 2009. Patients were stratified by number of arterial grafts into the LIMA plus saphenous veins (LIMA/SV) group (n=7435) or the MultArt group (n=1187). Propensity score analysis matched 1153 patients. Operative mortality was 0.8% (n=10) in the MultArt and 2.1% (n=154) in the LIMA/SV (P=0.005) group, which was not statistically different (P=0.996) in multivariate analysis or the propensity-matched analysis (P=0.818). Late survival was greater for MultArt versus LIMA/SV (10- and 15-year survival rates were 84% and 71% versus 61% and 36%, respectively [P<0.001], in unmatched groups and 83% and 70% versus 80% and 60%, respectively [P=0.0025], in matched groups). MultArt subgroups with bilateral internal mammary artery/SV (n=589) and bilateral internal mammary artery only (n=271) had improved 15-year survival (86% and 76%; 82% and 75% at 10 and 15 years [P<0.001]), and patients with bilateral internal mammary artery/radial artery (n=147) and LIMA/radial artery (n=169) had greater 10-year survival (84% and 78%; P<0.001) versus LIMA/SV. In multivariate analysis, MultArt grafts remained a strong independent predictor of survival (hazard ratio, 0.79; 95% confidence interval, 0.66-0.94; P=0.007). Conclusions-In patients undergoing isolated coronary artery bypass graft surgery with LIMA to left anterior descending artery, arterial grafting of the non-left anterior descending 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.

Original languageEnglish (US)
Pages (from-to)1023-1030
Number of pages8
JournalCirculation
Volume126
Issue number9
DOIs
StatePublished - Aug 21 2012

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Mammary Arteries
Coronary Artery Bypass
Transplants
Survival
Radial Artery
Coronary Artery Disease
Multivariate Analysis
Propensity Score
Saphenous Vein
Research Design
Survival Rate
Arteries
Confidence Intervals

Keywords

  • Grafting
  • Internal mammary arteries
  • Radial artery
  • Revascularization
  • Saphenous vein

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Multiple arterial grafts improve late survival of patients undergoing coronary artery bypass graft surgery : Analysis of 8622 patients with multivessel disease. / Locker, Chaim; Schaff, Hartzell V; Dearani, Joseph A.; Joyce, Lyle D.; Park, Soon J.; Burkhart, Harold M.; Suri, Rakesh M.; Greason, Kevin L.; Stulak, John M.; Li, Zhuo; Daly, Richard C.

In: Circulation, Vol. 126, No. 9, 21.08.2012, p. 1023-1030.

Research output: Contribution to journalArticle

Locker, C, Schaff, HV, Dearani, JA, Joyce, LD, Park, SJ, Burkhart, HM, Suri, RM, Greason, KL, Stulak, JM, Li, Z & Daly, RC 2012, 'Multiple arterial grafts improve late survival of patients undergoing coronary artery bypass graft surgery: Analysis of 8622 patients with multivessel disease', Circulation, vol. 126, no. 9, pp. 1023-1030. https://doi.org/10.1161/CIRCULATIONAHA.111.084624
Locker, Chaim ; Schaff, Hartzell V ; Dearani, Joseph A. ; Joyce, Lyle D. ; Park, Soon J. ; Burkhart, Harold M. ; Suri, Rakesh M. ; Greason, Kevin L. ; Stulak, John M. ; Li, Zhuo ; Daly, Richard C. / Multiple arterial grafts improve late survival of patients undergoing coronary artery bypass graft surgery : Analysis of 8622 patients with multivessel disease. In: Circulation. 2012 ; Vol. 126, No. 9. pp. 1023-1030.
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abstract = "Background-Use of the left internal mammary artery (LIMA) in multivessel coronary artery disease improves survival after coronary artery bypass graft surgery; however, the survival benefit of multiple arterial (MultArt) grafts is debated. Methods and Results-We reviewed 8622 Mayo Clinic patients who had isolated primary coronary artery bypass graft surgery for multivessel coronary artery disease from 1993 to 2009. Patients were stratified by number of arterial grafts into the LIMA plus saphenous veins (LIMA/SV) group (n=7435) or the MultArt group (n=1187). Propensity score analysis matched 1153 patients. Operative mortality was 0.8{\%} (n=10) in the MultArt and 2.1{\%} (n=154) in the LIMA/SV (P=0.005) group, which was not statistically different (P=0.996) in multivariate analysis or the propensity-matched analysis (P=0.818). Late survival was greater for MultArt versus LIMA/SV (10- and 15-year survival rates were 84{\%} and 71{\%} versus 61{\%} and 36{\%}, respectively [P<0.001], in unmatched groups and 83{\%} and 70{\%} versus 80{\%} and 60{\%}, respectively [P=0.0025], in matched groups). MultArt subgroups with bilateral internal mammary artery/SV (n=589) and bilateral internal mammary artery only (n=271) had improved 15-year survival (86{\%} and 76{\%}; 82{\%} and 75{\%} at 10 and 15 years [P<0.001]), and patients with bilateral internal mammary artery/radial artery (n=147) and LIMA/radial artery (n=169) had greater 10-year survival (84{\%} and 78{\%}; P<0.001) versus LIMA/SV. In multivariate analysis, MultArt grafts remained a strong independent predictor of survival (hazard ratio, 0.79; 95{\%} confidence interval, 0.66-0.94; P=0.007). Conclusions-In patients undergoing isolated coronary artery bypass graft surgery with LIMA to left anterior descending artery, arterial grafting of the non-left anterior descending 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.",
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T1 - Multiple arterial grafts improve late survival of patients undergoing coronary artery bypass graft surgery

T2 - Analysis of 8622 patients with multivessel disease

AU - Locker, Chaim

AU - Schaff, Hartzell V

AU - Dearani, Joseph A.

AU - Joyce, Lyle D.

AU - Park, Soon J.

AU - Burkhart, Harold M.

AU - Suri, Rakesh M.

AU - Greason, Kevin L.

AU - Stulak, John M.

AU - Li, Zhuo

AU - Daly, Richard C.

PY - 2012/8/21

Y1 - 2012/8/21

N2 - Background-Use of the left internal mammary artery (LIMA) in multivessel coronary artery disease improves survival after coronary artery bypass graft surgery; however, the survival benefit of multiple arterial (MultArt) grafts is debated. Methods and Results-We reviewed 8622 Mayo Clinic patients who had isolated primary coronary artery bypass graft surgery for multivessel coronary artery disease from 1993 to 2009. Patients were stratified by number of arterial grafts into the LIMA plus saphenous veins (LIMA/SV) group (n=7435) or the MultArt group (n=1187). Propensity score analysis matched 1153 patients. Operative mortality was 0.8% (n=10) in the MultArt and 2.1% (n=154) in the LIMA/SV (P=0.005) group, which was not statistically different (P=0.996) in multivariate analysis or the propensity-matched analysis (P=0.818). Late survival was greater for MultArt versus LIMA/SV (10- and 15-year survival rates were 84% and 71% versus 61% and 36%, respectively [P<0.001], in unmatched groups and 83% and 70% versus 80% and 60%, respectively [P=0.0025], in matched groups). MultArt subgroups with bilateral internal mammary artery/SV (n=589) and bilateral internal mammary artery only (n=271) had improved 15-year survival (86% and 76%; 82% and 75% at 10 and 15 years [P<0.001]), and patients with bilateral internal mammary artery/radial artery (n=147) and LIMA/radial artery (n=169) had greater 10-year survival (84% and 78%; P<0.001) versus LIMA/SV. In multivariate analysis, MultArt grafts remained a strong independent predictor of survival (hazard ratio, 0.79; 95% confidence interval, 0.66-0.94; P=0.007). Conclusions-In patients undergoing isolated coronary artery bypass graft surgery with LIMA to left anterior descending artery, arterial grafting of the non-left anterior descending 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.

AB - Background-Use of the left internal mammary artery (LIMA) in multivessel coronary artery disease improves survival after coronary artery bypass graft surgery; however, the survival benefit of multiple arterial (MultArt) grafts is debated. Methods and Results-We reviewed 8622 Mayo Clinic patients who had isolated primary coronary artery bypass graft surgery for multivessel coronary artery disease from 1993 to 2009. Patients were stratified by number of arterial grafts into the LIMA plus saphenous veins (LIMA/SV) group (n=7435) or the MultArt group (n=1187). Propensity score analysis matched 1153 patients. Operative mortality was 0.8% (n=10) in the MultArt and 2.1% (n=154) in the LIMA/SV (P=0.005) group, which was not statistically different (P=0.996) in multivariate analysis or the propensity-matched analysis (P=0.818). Late survival was greater for MultArt versus LIMA/SV (10- and 15-year survival rates were 84% and 71% versus 61% and 36%, respectively [P<0.001], in unmatched groups and 83% and 70% versus 80% and 60%, respectively [P=0.0025], in matched groups). MultArt subgroups with bilateral internal mammary artery/SV (n=589) and bilateral internal mammary artery only (n=271) had improved 15-year survival (86% and 76%; 82% and 75% at 10 and 15 years [P<0.001]), and patients with bilateral internal mammary artery/radial artery (n=147) and LIMA/radial artery (n=169) had greater 10-year survival (84% and 78%; P<0.001) versus LIMA/SV. In multivariate analysis, MultArt grafts remained a strong independent predictor of survival (hazard ratio, 0.79; 95% confidence interval, 0.66-0.94; P=0.007). Conclusions-In patients undergoing isolated coronary artery bypass graft surgery with LIMA to left anterior descending artery, arterial grafting of the non-left anterior descending 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.

KW - Grafting

KW - Internal mammary arteries

KW - Radial artery

KW - Revascularization

KW - Saphenous vein

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