Multiple Versus Single Arterial Coronary Bypass Graft Surgery for Multivessel Disease
Despite recent guideline statements, there is still wide practice variation in the use of multiple arterial grafts (MAGs) versus single arterial grafts (SAGs) for patients with multivessel disease undergoing coronary artery bypass graft surgery. This may be related to differences in findings between...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2019-09, Vol.74 (10), p.1275-1285 |
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| creator | Samadashvili, Zaza Sundt, Thoralf M. Wechsler, Andrew Chikwe, Joanna Adams, David H. Smith, Craig R. Jordan, Desmond Girardi, Leonard Lahey, Stephen J. Gold, Jeffrey P. Ashraf, Mohammed H. Hannan, Edward L. |
| description | Despite recent guideline statements, there is still wide practice variation in the use of multiple arterial grafts (MAGs) versus single arterial grafts (SAGs) for patients with multivessel disease undergoing coronary artery bypass graft surgery. This may be related to differences in findings between observational and randomized controlled studies.
This study sought to compare intermediate-term MAG and SAG outcomes with enhanced matching to reduce selection bias.
New York’s cardiac registry identified 63,402 multivessel disease patients undergoing coronary artery bypass graft surgery between January 1, 2005, and December 31, 2014, to compare outcomes (median follow-up 6.5 years) for patients receiving SAGs and MAGs. SAG and MAG patients were propensity matched using 38 baseline characteristics to reduce selection bias. The primary endpoint was mortality, and secondary endpoints included repeat revascularization and a composite endpoint of mortality, acute myocardial infarction, and stroke.
Before matching, 20% of procedures employed MAG. At 1 year, there was no mortality difference between matched MAG and SAG patients (2.4% vs. 2.2%, adjusted hazard ratio [AHR]: 1.11; 95% confidence interval [CI]: 0.93 to 1.32). At 7 years, MAG patients had lower mortality (12.7% vs. 14.3%, AHR: 0.86; 95% CI: 0.79 to 0.93), a lower composite outcome (20.2% vs. 22.8%, AHR: 0.88; 95% CI: 0.83 to 0.93), and a lower repeat revascularization rate (11.7% vs. 14.6%, AHR: 0.80; 95% CI: 0.74 to 0.87). At 7 years, the subgroups for which MAG did not have a lower mortality rate included patients with off-pump surgery, 2-vessel disease with right coronary artery disease, recent acute myocardial infarction, renal dysfunction, and patient ≥70 years of age.
Mortality and the composite outcome were similar between MAG and SAG patients at 1 year, but lower for MAG after 7 years. Patients of higher volume MAG surgeons experienced lower MAG mortality.
[Display omitted] |
| doi_str_mv | 10.1016/j.jacc.2019.06.067 |
| format | Article |
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This study sought to compare intermediate-term MAG and SAG outcomes with enhanced matching to reduce selection bias.
New York’s cardiac registry identified 63,402 multivessel disease patients undergoing coronary artery bypass graft surgery between January 1, 2005, and December 31, 2014, to compare outcomes (median follow-up 6.5 years) for patients receiving SAGs and MAGs. SAG and MAG patients were propensity matched using 38 baseline characteristics to reduce selection bias. The primary endpoint was mortality, and secondary endpoints included repeat revascularization and a composite endpoint of mortality, acute myocardial infarction, and stroke.
Before matching, 20% of procedures employed MAG. At 1 year, there was no mortality difference between matched MAG and SAG patients (2.4% vs. 2.2%, adjusted hazard ratio [AHR]: 1.11; 95% confidence interval [CI]: 0.93 to 1.32). At 7 years, MAG patients had lower mortality (12.7% vs. 14.3%, AHR: 0.86; 95% CI: 0.79 to 0.93), a lower composite outcome (20.2% vs. 22.8%, AHR: 0.88; 95% CI: 0.83 to 0.93), and a lower repeat revascularization rate (11.7% vs. 14.6%, AHR: 0.80; 95% CI: 0.74 to 0.87). At 7 years, the subgroups for which MAG did not have a lower mortality rate included patients with off-pump surgery, 2-vessel disease with right coronary artery disease, recent acute myocardial infarction, renal dysfunction, and patient ≥70 years of age.
Mortality and the composite outcome were similar between MAG and SAG patients at 1 year, but lower for MAG after 7 years. Patients of higher volume MAG surgeons experienced lower MAG mortality.
[Display omitted]</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2019.06.067</identifier><identifier>PMID: 31488263</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Bias ; CABG surgery ; Cardiology ; Cardiovascular disease ; Cerebral infarction ; Confidence intervals ; Coronary artery ; Coronary Artery Bypass - adverse effects ; Coronary Artery Bypass - methods ; Coronary Artery Bypass - mortality ; Coronary artery disease ; Coronary Artery Disease - diagnosis ; Coronary Artery Disease - surgery ; Coronary vessels ; Coronary Vessels - pathology ; Coronary Vessels - surgery ; Diabetes ; Female ; Grafting ; Grafts ; Heart diseases ; Heart surgery ; Hospitals ; Humans ; Identification methods ; MACE ; Male ; Matching ; Middle Aged ; Mortality ; mortality differences ; multiple arterial revascularization ; multiple vessel disease ; Myocardial infarction ; Myocardial Infarction - epidemiology ; Myocardial Infarction - etiology ; New York - epidemiology ; Observational studies ; observational study ; Outcome and Process Assessment, Health Care ; Patients ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Registries - statistics & numerical data ; Renal function ; Reoperation - statistics & numerical data ; Sag ; Severity of Illness Index ; Stents ; Stroke ; Stroke - epidemiology ; Stroke - etiology ; Studies ; Subgroups ; Surgeons ; Surgery ; Vital statistics</subject><ispartof>Journal of the American College of Cardiology, 2019-09, Vol.74 (10), p.1275-1285</ispartof><rights>2019 American College of Cardiology Foundation</rights><rights>Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><rights>2019. American College of Cardiology Foundation</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-9014d95efef257785adf8bdf4ea7b98e8bfad890b949c7002b95191d1bb35d7c3</citedby><cites>FETCH-LOGICAL-c428t-9014d95efef257785adf8bdf4ea7b98e8bfad890b949c7002b95191d1bb35d7c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jacc.2019.06.067$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31488263$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Samadashvili, Zaza</creatorcontrib><creatorcontrib>Sundt, Thoralf M.</creatorcontrib><creatorcontrib>Wechsler, Andrew</creatorcontrib><creatorcontrib>Chikwe, Joanna</creatorcontrib><creatorcontrib>Adams, David H.</creatorcontrib><creatorcontrib>Smith, Craig R.</creatorcontrib><creatorcontrib>Jordan, Desmond</creatorcontrib><creatorcontrib>Girardi, Leonard</creatorcontrib><creatorcontrib>Lahey, Stephen J.</creatorcontrib><creatorcontrib>Gold, Jeffrey P.</creatorcontrib><creatorcontrib>Ashraf, Mohammed H.</creatorcontrib><creatorcontrib>Hannan, Edward L.</creatorcontrib><title>Multiple Versus Single Arterial Coronary Bypass Graft Surgery for Multivessel Disease</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Despite recent guideline statements, there is still wide practice variation in the use of multiple arterial grafts (MAGs) versus single arterial grafts (SAGs) for patients with multivessel disease undergoing coronary artery bypass graft surgery. This may be related to differences in findings between observational and randomized controlled studies.
This study sought to compare intermediate-term MAG and SAG outcomes with enhanced matching to reduce selection bias.
New York’s cardiac registry identified 63,402 multivessel disease patients undergoing coronary artery bypass graft surgery between January 1, 2005, and December 31, 2014, to compare outcomes (median follow-up 6.5 years) for patients receiving SAGs and MAGs. SAG and MAG patients were propensity matched using 38 baseline characteristics to reduce selection bias. The primary endpoint was mortality, and secondary endpoints included repeat revascularization and a composite endpoint of mortality, acute myocardial infarction, and stroke.
Before matching, 20% of procedures employed MAG. At 1 year, there was no mortality difference between matched MAG and SAG patients (2.4% vs. 2.2%, adjusted hazard ratio [AHR]: 1.11; 95% confidence interval [CI]: 0.93 to 1.32). At 7 years, MAG patients had lower mortality (12.7% vs. 14.3%, AHR: 0.86; 95% CI: 0.79 to 0.93), a lower composite outcome (20.2% vs. 22.8%, AHR: 0.88; 95% CI: 0.83 to 0.93), and a lower repeat revascularization rate (11.7% vs. 14.6%, AHR: 0.80; 95% CI: 0.74 to 0.87). At 7 years, the subgroups for which MAG did not have a lower mortality rate included patients with off-pump surgery, 2-vessel disease with right coronary artery disease, recent acute myocardial infarction, renal dysfunction, and patient ≥70 years of age.
Mortality and the composite outcome were similar between MAG and SAG patients at 1 year, but lower for MAG after 7 years. Patients of higher volume MAG surgeons experienced lower MAG mortality.
[Display omitted]</description><subject>Bias</subject><subject>CABG surgery</subject><subject>Cardiology</subject><subject>Cardiovascular disease</subject><subject>Cerebral infarction</subject><subject>Confidence intervals</subject><subject>Coronary artery</subject><subject>Coronary Artery Bypass - adverse effects</subject><subject>Coronary Artery Bypass - methods</subject><subject>Coronary Artery Bypass - mortality</subject><subject>Coronary artery disease</subject><subject>Coronary Artery Disease - diagnosis</subject><subject>Coronary Artery Disease - surgery</subject><subject>Coronary vessels</subject><subject>Coronary Vessels - pathology</subject><subject>Coronary Vessels - surgery</subject><subject>Diabetes</subject><subject>Female</subject><subject>Grafting</subject><subject>Grafts</subject><subject>Heart diseases</subject><subject>Heart surgery</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Identification methods</subject><subject>MACE</subject><subject>Male</subject><subject>Matching</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>mortality differences</subject><subject>multiple arterial revascularization</subject><subject>multiple vessel disease</subject><subject>Myocardial infarction</subject><subject>Myocardial Infarction - epidemiology</subject><subject>Myocardial Infarction - etiology</subject><subject>New York - epidemiology</subject><subject>Observational studies</subject><subject>observational study</subject><subject>Outcome and Process Assessment, Health Care</subject><subject>Patients</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Registries - statistics & numerical data</subject><subject>Renal function</subject><subject>Reoperation - statistics & numerical data</subject><subject>Sag</subject><subject>Severity of Illness Index</subject><subject>Stents</subject><subject>Stroke</subject><subject>Stroke - epidemiology</subject><subject>Stroke - etiology</subject><subject>Studies</subject><subject>Subgroups</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Vital statistics</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtq3DAUQEVpaaZJfqCLYuimG08k2bIk6CadNmkgIYs8tkKWroKMx57q2oH5m35LvqyaTNpFFoULQnB00D2EfGR0yShrTrplZ51bcsr0kjZ55BuyYEKoshJaviULKitRMqrlAfmA2FFKG8X0e3JQsVop3lQLcn8191Pc9FDcQ8IZi5s4POTbaZogRdsXqzGNg03bp9_fthuLWJwnG6biZk4PkLZFGFPxrHgEROiL7xHBIhyRd8H2CMcv5yG5O_txu_pZXl6fX6xOL0tXczWVmrLaawEBAhdSKmF9UK0PNVjZagWqDdYrTVtdaycp5a0WTDPP2rYSXrrqkHzZezdp_DUDTmYd0UHf2wHGGQ3nqtFUSSEz-vkV2o1zGvLvDK-YkkwJoTPF95RLI2KCYDYprvP-hlGzq246s6tudtUNbfLs1J9e1HO7Bv_vyd_MGfi6ByC3eIyQDLoIgwMfE7jJ-DH-z_8HRmKUSw</recordid><startdate>20190910</startdate><enddate>20190910</enddate><creator>Samadashvili, Zaza</creator><creator>Sundt, Thoralf M.</creator><creator>Wechsler, Andrew</creator><creator>Chikwe, Joanna</creator><creator>Adams, David H.</creator><creator>Smith, Craig R.</creator><creator>Jordan, Desmond</creator><creator>Girardi, Leonard</creator><creator>Lahey, Stephen J.</creator><creator>Gold, Jeffrey P.</creator><creator>Ashraf, Mohammed H.</creator><creator>Hannan, Edward L.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20190910</creationdate><title>Multiple Versus Single Arterial Coronary Bypass Graft Surgery for Multivessel Disease</title><author>Samadashvili, Zaza ; Sundt, Thoralf M. ; Wechsler, Andrew ; Chikwe, Joanna ; Adams, David H. ; Smith, Craig R. ; Jordan, Desmond ; Girardi, Leonard ; Lahey, Stephen J. ; Gold, Jeffrey P. ; Ashraf, Mohammed H. ; Hannan, Edward L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c428t-9014d95efef257785adf8bdf4ea7b98e8bfad890b949c7002b95191d1bb35d7c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Bias</topic><topic>CABG surgery</topic><topic>Cardiology</topic><topic>Cardiovascular disease</topic><topic>Cerebral infarction</topic><topic>Confidence intervals</topic><topic>Coronary artery</topic><topic>Coronary Artery Bypass - adverse effects</topic><topic>Coronary Artery Bypass - methods</topic><topic>Coronary Artery Bypass - mortality</topic><topic>Coronary artery disease</topic><topic>Coronary Artery Disease - diagnosis</topic><topic>Coronary Artery Disease - surgery</topic><topic>Coronary vessels</topic><topic>Coronary Vessels - pathology</topic><topic>Coronary Vessels - surgery</topic><topic>Diabetes</topic><topic>Female</topic><topic>Grafting</topic><topic>Grafts</topic><topic>Heart diseases</topic><topic>Heart surgery</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Identification methods</topic><topic>MACE</topic><topic>Male</topic><topic>Matching</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>mortality differences</topic><topic>multiple arterial revascularization</topic><topic>multiple vessel disease</topic><topic>Myocardial infarction</topic><topic>Myocardial Infarction - epidemiology</topic><topic>Myocardial Infarction - etiology</topic><topic>New York - epidemiology</topic><topic>Observational studies</topic><topic>observational study</topic><topic>Outcome and Process Assessment, Health Care</topic><topic>Patients</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Registries - statistics & numerical data</topic><topic>Renal function</topic><topic>Reoperation - statistics & numerical data</topic><topic>Sag</topic><topic>Severity of Illness Index</topic><topic>Stents</topic><topic>Stroke</topic><topic>Stroke - epidemiology</topic><topic>Stroke - etiology</topic><topic>Studies</topic><topic>Subgroups</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Vital statistics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Samadashvili, Zaza</creatorcontrib><creatorcontrib>Sundt, Thoralf M.</creatorcontrib><creatorcontrib>Wechsler, Andrew</creatorcontrib><creatorcontrib>Chikwe, Joanna</creatorcontrib><creatorcontrib>Adams, David H.</creatorcontrib><creatorcontrib>Smith, Craig R.</creatorcontrib><creatorcontrib>Jordan, Desmond</creatorcontrib><creatorcontrib>Girardi, Leonard</creatorcontrib><creatorcontrib>Lahey, Stephen J.</creatorcontrib><creatorcontrib>Gold, Jeffrey P.</creatorcontrib><creatorcontrib>Ashraf, Mohammed H.</creatorcontrib><creatorcontrib>Hannan, Edward L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Samadashvili, Zaza</au><au>Sundt, Thoralf M.</au><au>Wechsler, Andrew</au><au>Chikwe, Joanna</au><au>Adams, David H.</au><au>Smith, Craig R.</au><au>Jordan, Desmond</au><au>Girardi, Leonard</au><au>Lahey, Stephen J.</au><au>Gold, Jeffrey P.</au><au>Ashraf, Mohammed H.</au><au>Hannan, Edward L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multiple Versus Single Arterial Coronary Bypass Graft Surgery for Multivessel Disease</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2019-09-10</date><risdate>2019</risdate><volume>74</volume><issue>10</issue><spage>1275</spage><epage>1285</epage><pages>1275-1285</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><abstract>Despite recent guideline statements, there is still wide practice variation in the use of multiple arterial grafts (MAGs) versus single arterial grafts (SAGs) for patients with multivessel disease undergoing coronary artery bypass graft surgery. This may be related to differences in findings between observational and randomized controlled studies.
This study sought to compare intermediate-term MAG and SAG outcomes with enhanced matching to reduce selection bias.
New York’s cardiac registry identified 63,402 multivessel disease patients undergoing coronary artery bypass graft surgery between January 1, 2005, and December 31, 2014, to compare outcomes (median follow-up 6.5 years) for patients receiving SAGs and MAGs. SAG and MAG patients were propensity matched using 38 baseline characteristics to reduce selection bias. The primary endpoint was mortality, and secondary endpoints included repeat revascularization and a composite endpoint of mortality, acute myocardial infarction, and stroke.
Before matching, 20% of procedures employed MAG. At 1 year, there was no mortality difference between matched MAG and SAG patients (2.4% vs. 2.2%, adjusted hazard ratio [AHR]: 1.11; 95% confidence interval [CI]: 0.93 to 1.32). At 7 years, MAG patients had lower mortality (12.7% vs. 14.3%, AHR: 0.86; 95% CI: 0.79 to 0.93), a lower composite outcome (20.2% vs. 22.8%, AHR: 0.88; 95% CI: 0.83 to 0.93), and a lower repeat revascularization rate (11.7% vs. 14.6%, AHR: 0.80; 95% CI: 0.74 to 0.87). At 7 years, the subgroups for which MAG did not have a lower mortality rate included patients with off-pump surgery, 2-vessel disease with right coronary artery disease, recent acute myocardial infarction, renal dysfunction, and patient ≥70 years of age.
Mortality and the composite outcome were similar between MAG and SAG patients at 1 year, but lower for MAG after 7 years. Patients of higher volume MAG surgeons experienced lower MAG mortality.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31488263</pmid><doi>10.1016/j.jacc.2019.06.067</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Bias CABG surgery Cardiology Cardiovascular disease Cerebral infarction Confidence intervals Coronary artery Coronary Artery Bypass - adverse effects Coronary Artery Bypass - methods Coronary Artery Bypass - mortality Coronary artery disease Coronary Artery Disease - diagnosis Coronary Artery Disease - surgery Coronary vessels Coronary Vessels - pathology Coronary Vessels - surgery Diabetes Female Grafting Grafts Heart diseases Heart surgery Hospitals Humans Identification methods MACE Male Matching Middle Aged Mortality mortality differences multiple arterial revascularization multiple vessel disease Myocardial infarction Myocardial Infarction - epidemiology Myocardial Infarction - etiology New York - epidemiology Observational studies observational study Outcome and Process Assessment, Health Care Patients Postoperative Complications - epidemiology Postoperative Complications - etiology Registries - statistics & numerical data Renal function Reoperation - statistics & numerical data Sag Severity of Illness Index Stents Stroke Stroke - epidemiology Stroke - etiology Studies Subgroups Surgeons Surgery Vital statistics |
| title | Multiple Versus Single Arterial Coronary Bypass Graft Surgery for Multivessel Disease |
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