Multiple Arterial Grafts Improve Late Survival of Multivessel Disease Patients Undergoing Cabg

摘要

Coronary artery revascularization strategies are evolving. In comparisons of all new strategies, their impact on survival is probably the most important factor. It has long been accepted that using the left internal mammary artery (LIMA) to bypass the left anterior descending coronary artery (LAD) is the gold standard and may confer the survival advantage reported for coronary artery bypass grafting (CABG) surgery compared with percutaneous coronary intervention. The survival advantage obtained with using additional arterial conduits compared to the conventional use of LIMA with saphenous veins is yet to be confirmed. Our study, which involved a large cohort of 8622 patients with multivessel coronary artery disease (MVCAD), has shown that in primary isolated CABG surgery performed more than 15 years ago with the use of LIMA to the LAD, bypassing the non-LAD targets with at least 1 additional arterial graft, either the right internal mammary artery and/or the radial artery, was a strong independent predictor of survival during the following 15 years. The results were confirmed with both propensity-matched analysis including 2306 patients and a multivariable analysis that controlled for all differences between the groups due to the statistical power obtained from the large cohort. The significant survival advantage of CABG surgery with the use of multiple arterial grafting cannot be ignored anymore in patients with MVCAD.