In CABG, most outcomes similar in multiple vs. single arterial grafts
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Among patients who underwent CABG, single arterial grafts and multiple arterial grafts were similar for all-cause mortality, CV mortality, MI and major bleeding, researchers reported.
However, CABG with multiple arterial grafts conferred reduced risk for stroke and repeat revascularization, according to a meta-analysis published in the American Journal of Cardiology.
In addition, CABG with multiple arterial grafts was associated with greater incidence of sternal wound complications, compared with CABG with single arterial grafts.
“The predominant evidence supporting the use of MAGs is observational,” Khalid Changal, MD, of the department of cardiovascular medicine at University of Toledo Health Sciences, and colleagues wrote. “The aim of this meta-analysis of randomized controlled trials is to compare outcomes following MAG and SAG.”
For the meta-analysis, researchers assessed 10 randomized controlled trials that compared CABG with single arterial grafts with multiple arterial grafts. Patients included in the meta-analysis (n = 6,392) were on average 56 to 75 years of age and followed up for a mean of 4 years.
Compared with CABG with single arterial grafts, researchers observed no between-group differences for patients who underwent CABG with multiple arterial grafts for all-cause mortality (HR = 0.94; 95% CI, 0.81-1.09), CV mortality (HR = 0.96; 95% CI, 0.74-1.26), MI (HR = 0.87; 95% CI, 0.67-1.12) and major bleeding (RR = 0.85; 95% CI, 0.64-1.13).
Those who had multiple arterial grafts had lower risk for stroke compared with those who had single arterial grafts (RR = 0.74; 95% CI, 0.56-0.98), according to the researchers.
After researchers removed one of the confounding studies from the analysis, CABG with multiple arterial grafts was linked to less repeat revascularization compared with single arterial grafts (RR = 0.63; 95% CI, 0.4-0.99).
However, compared with those who had CABG with single arterial grafts, patients who underwent multiple arterial grafts experienced greater incidence of sternal wound complications (RR = 1.75; 95% CI, 1.19-2.55).
“MAG does not have a survival advantage over SAG but has better revascularization and stroke outcomes in randomized data,” the researchers wrote. “This benefit may be offset by a higher incidence of sternal wound complications in MAG. Till further evidence is available, we suggest that the decision to use MAG or SAG should be individualized by taking the revascularization, stroke and wound complication rates in to consideration.”
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