Loading…
Outcomes of Second Arterial Conduits in Patients Undergoing Multivessel Coronary Artery Bypass Graft Surgery
Benefits of multiarterial versus single-arterial coronary bypass grafting (CABG) are debated. This study sought to compare long-term survival, morbidity, and graft patency after multiarterial versus single-arterial CABG. Mandatory clinical registries linked with discharge databases were used to iden...
Saved in:
| Published in: | Journal of the American College of Cardiology 2019-11, Vol.74 (18), p.2238-2248 |
|---|---|
| Main Authors: | , , , , , , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Citations: | Items that this one cites Items that cite this one |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| cited_by | cdi_FETCH-LOGICAL-c399t-b4b4b84ef6382eaade757a392801687f14e3d75b74f0e04522d4cb3fd02a51c53 |
|---|---|
| cites | cdi_FETCH-LOGICAL-c399t-b4b4b84ef6382eaade757a392801687f14e3d75b74f0e04522d4cb3fd02a51c53 |
| container_end_page | 2248 |
| container_issue | 18 |
| container_start_page | 2238 |
| container_title | Journal of the American College of Cardiology |
| container_volume | 74 |
| creator | Chikwe, Joanna Sun, Erick Hannan, Edward L. Itagaki, Shinobu Lee, Timothy Adams, David H. Egorova, Natalia N. |
| description | Benefits of multiarterial versus single-arterial coronary bypass grafting (CABG) are debated.
This study sought to compare long-term survival, morbidity, and graft patency after multiarterial versus single-arterial CABG.
Mandatory clinical registries linked with discharge databases were used to identify baseline and operative characteristics and outcomes of 42,714 patients undergoing CABG from 2005 through 2012. Patients with single-vessel disease, without arterial conduits, or undergoing emergency, reoperative, or concomitant procedures were excluded. Survival, stroke, myocardial infarction, and repeat revascularization rates were compared using Cox modeling, and patients were matched by propensity score. Median follow-up was 7.8 years (interquartile range: 5 to 10 years); last follow-up was December 31, 2016.
Of the 26,124 patients, 3,647 (14.0%) underwent multiarterial CABG. Single-arterial CABG patients were older (mean 68 vs. 61 years; p |
| doi_str_mv | 10.1016/j.jacc.2019.08.1043 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2309736316</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0735109719376478</els_id><sourcerecordid>2309736316</sourcerecordid><originalsourceid>FETCH-LOGICAL-c399t-b4b4b84ef6382eaade757a392801687f14e3d75b74f0e04522d4cb3fd02a51c53</originalsourceid><addsrcrecordid>eNp9kN1KAzEQhYMoWn-eQJCA11uTzWaze-GFFv9AqVC9DmkyW7K0m5pkC30bn8UnM0vVS5mLYYZzZjgfQueUjCmh5VU7bpXW45zQekyqtCvYHhpRzquM8VrsoxERjGeU1OIIHYfQEkLKitaH6IjRUuRU1CO0mvZRuxUE7Bo8A-06g298BG_VEk_S1NsYsO2-Pl9VtNCl4b0z4BfOdgv80i-j3UAIMIi965Tf7uxbfLtdqxDwg1dNxLPeL9LyFB00ahng7KefoPf7u7fJY_Y8fXia3DxnmtV1zOZFqqqApmRVDkoZEFwoVudVyl2JhhbAjOBzUTQESMHz3BR6zhpDcsWp5uwEXe7urr376CFE2bred-mlzFniwcpEIKnYTqW9C8FDI9ferlIESYkcEMtWDojlgFiSSg6Ik-vi53Y_X4H58_wyTYLrnQBSwo0FL4NO5DQY60FHaZz998E3jkWPAQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2309736316</pqid></control><display><type>article</type><title>Outcomes of Second Arterial Conduits in Patients Undergoing Multivessel Coronary Artery Bypass Graft Surgery</title><source>BACON - Elsevier - GLOBAL_SCIENCEDIRECT-OPENACCESS</source><creator>Chikwe, Joanna ; Sun, Erick ; Hannan, Edward L. ; Itagaki, Shinobu ; Lee, Timothy ; Adams, David H. ; Egorova, Natalia N.</creator><creatorcontrib>Chikwe, Joanna ; Sun, Erick ; Hannan, Edward L. ; Itagaki, Shinobu ; Lee, Timothy ; Adams, David H. ; Egorova, Natalia N.</creatorcontrib><description>Benefits of multiarterial versus single-arterial coronary bypass grafting (CABG) are debated.
This study sought to compare long-term survival, morbidity, and graft patency after multiarterial versus single-arterial CABG.
Mandatory clinical registries linked with discharge databases were used to identify baseline and operative characteristics and outcomes of 42,714 patients undergoing CABG from 2005 through 2012. Patients with single-vessel disease, without arterial conduits, or undergoing emergency, reoperative, or concomitant procedures were excluded. Survival, stroke, myocardial infarction, and repeat revascularization rates were compared using Cox modeling, and patients were matched by propensity score. Median follow-up was 7.8 years (interquartile range: 5 to 10 years); last follow-up was December 31, 2016.
Of the 26,124 patients, 3,647 (14.0%) underwent multiarterial CABG. Single-arterial CABG patients were older (mean 68 vs. 61 years; p < 0.001), had more comorbidities, and received fewer bypass grafts (3.4 vs. 3.6; p < 0.001). After adjusting for baseline differences, multiarterial CABG was associated with lower 10-year mortality compared with single-arterial CABG in 3,588 propensity-matched pairs (15.1% vs. 17.3%; p = 0.01). Multiarterial CABG was associated with lower 10-year myocardial infarction (hazard ratio: 0.81; 95% confidence interval: 0.69 to 0.95) and lower 10-year reintervention rate (hazard ratio: 0.81; 95% confidence interval: 0.67 to 0.99).
In contemporary practice, single-arterial CABG is used in 85% of patients and is associated with increased long-term mortality, myocardial infarction, and reintervention compared with multiarterial CABG. Multiarterial CABG is underused in contemporary surgical revascularization, and targeted referral of younger patients for multiarterial revascularization may address this practice gap.
[Display omitted]</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2019.08.1043</identifier><identifier>PMID: 31672179</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; arterial graft ; Cardiology ; Cerebral infarction ; Clinical medicine ; Conduits ; Confidence intervals ; Coronary artery ; Coronary Artery Bypass ; Coronary Artery Disease - mortality ; Coronary Artery Disease - pathology ; Coronary Artery Disease - surgery ; coronary revascularization ; Coronary vessels ; Data collection ; Emergency procedures ; Female ; Grafting ; Grafts ; Health hazards ; Heart attacks ; Heart surgery ; Humans ; Identification methods ; Intubation ; Male ; Middle Aged ; Morbidity ; Mortality ; Myocardial infarction ; off-pump coronary bypass surgery ; on-pump coronary bypass surgery ; Patients ; Propensity Score ; Proportional Hazards Models ; Retrospective Studies ; Stroke ; Surgeons ; Survival ; Survival Rate ; Treatment Outcome ; Variables ; Vascular Patency ; Vital statistics</subject><ispartof>Journal of the American College of Cardiology, 2019-11, Vol.74 (18), p.2238-2248</ispartof><rights>2019</rights><rights>Copyright © 2019. Published by Elsevier Inc.</rights><rights>Copyright Elsevier Limited Nov 5, 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c399t-b4b4b84ef6382eaade757a392801687f14e3d75b74f0e04522d4cb3fd02a51c53</citedby><cites>FETCH-LOGICAL-c399t-b4b4b84ef6382eaade757a392801687f14e3d75b74f0e04522d4cb3fd02a51c53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31672179$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chikwe, Joanna</creatorcontrib><creatorcontrib>Sun, Erick</creatorcontrib><creatorcontrib>Hannan, Edward L.</creatorcontrib><creatorcontrib>Itagaki, Shinobu</creatorcontrib><creatorcontrib>Lee, Timothy</creatorcontrib><creatorcontrib>Adams, David H.</creatorcontrib><creatorcontrib>Egorova, Natalia N.</creatorcontrib><title>Outcomes of Second Arterial Conduits in Patients Undergoing Multivessel Coronary Artery Bypass Graft Surgery</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Benefits of multiarterial versus single-arterial coronary bypass grafting (CABG) are debated.
This study sought to compare long-term survival, morbidity, and graft patency after multiarterial versus single-arterial CABG.
Mandatory clinical registries linked with discharge databases were used to identify baseline and operative characteristics and outcomes of 42,714 patients undergoing CABG from 2005 through 2012. Patients with single-vessel disease, without arterial conduits, or undergoing emergency, reoperative, or concomitant procedures were excluded. Survival, stroke, myocardial infarction, and repeat revascularization rates were compared using Cox modeling, and patients were matched by propensity score. Median follow-up was 7.8 years (interquartile range: 5 to 10 years); last follow-up was December 31, 2016.
Of the 26,124 patients, 3,647 (14.0%) underwent multiarterial CABG. Single-arterial CABG patients were older (mean 68 vs. 61 years; p < 0.001), had more comorbidities, and received fewer bypass grafts (3.4 vs. 3.6; p < 0.001). After adjusting for baseline differences, multiarterial CABG was associated with lower 10-year mortality compared with single-arterial CABG in 3,588 propensity-matched pairs (15.1% vs. 17.3%; p = 0.01). Multiarterial CABG was associated with lower 10-year myocardial infarction (hazard ratio: 0.81; 95% confidence interval: 0.69 to 0.95) and lower 10-year reintervention rate (hazard ratio: 0.81; 95% confidence interval: 0.67 to 0.99).
In contemporary practice, single-arterial CABG is used in 85% of patients and is associated with increased long-term mortality, myocardial infarction, and reintervention compared with multiarterial CABG. Multiarterial CABG is underused in contemporary surgical revascularization, and targeted referral of younger patients for multiarterial revascularization may address this practice gap.
[Display omitted]</description><subject>Aged</subject><subject>arterial graft</subject><subject>Cardiology</subject><subject>Cerebral infarction</subject><subject>Clinical medicine</subject><subject>Conduits</subject><subject>Confidence intervals</subject><subject>Coronary artery</subject><subject>Coronary Artery Bypass</subject><subject>Coronary Artery Disease - mortality</subject><subject>Coronary Artery Disease - pathology</subject><subject>Coronary Artery Disease - surgery</subject><subject>coronary revascularization</subject><subject>Coronary vessels</subject><subject>Data collection</subject><subject>Emergency procedures</subject><subject>Female</subject><subject>Grafting</subject><subject>Grafts</subject><subject>Health hazards</subject><subject>Heart attacks</subject><subject>Heart surgery</subject><subject>Humans</subject><subject>Identification methods</subject><subject>Intubation</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>off-pump coronary bypass surgery</subject><subject>on-pump coronary bypass surgery</subject><subject>Patients</subject><subject>Propensity Score</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Stroke</subject><subject>Surgeons</subject><subject>Survival</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><subject>Variables</subject><subject>Vascular Patency</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><recordid>eNp9kN1KAzEQhYMoWn-eQJCA11uTzWaze-GFFv9AqVC9DmkyW7K0m5pkC30bn8UnM0vVS5mLYYZzZjgfQueUjCmh5VU7bpXW45zQekyqtCvYHhpRzquM8VrsoxERjGeU1OIIHYfQEkLKitaH6IjRUuRU1CO0mvZRuxUE7Bo8A-06g298BG_VEk_S1NsYsO2-Pl9VtNCl4b0z4BfOdgv80i-j3UAIMIi965Tf7uxbfLtdqxDwg1dNxLPeL9LyFB00ahng7KefoPf7u7fJY_Y8fXia3DxnmtV1zOZFqqqApmRVDkoZEFwoVudVyl2JhhbAjOBzUTQESMHz3BR6zhpDcsWp5uwEXe7urr376CFE2bred-mlzFniwcpEIKnYTqW9C8FDI9ferlIESYkcEMtWDojlgFiSSg6Ik-vi53Y_X4H58_wyTYLrnQBSwo0FL4NO5DQY60FHaZz998E3jkWPAQ</recordid><startdate>20191105</startdate><enddate>20191105</enddate><creator>Chikwe, Joanna</creator><creator>Sun, Erick</creator><creator>Hannan, Edward L.</creator><creator>Itagaki, Shinobu</creator><creator>Lee, Timothy</creator><creator>Adams, David H.</creator><creator>Egorova, Natalia N.</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></search><sort><creationdate>20191105</creationdate><title>Outcomes of Second Arterial Conduits in Patients Undergoing Multivessel Coronary Artery Bypass Graft Surgery</title><author>Chikwe, Joanna ; Sun, Erick ; Hannan, Edward L. ; Itagaki, Shinobu ; Lee, Timothy ; Adams, David H. ; Egorova, Natalia N.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c399t-b4b4b84ef6382eaade757a392801687f14e3d75b74f0e04522d4cb3fd02a51c53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>arterial graft</topic><topic>Cardiology</topic><topic>Cerebral infarction</topic><topic>Clinical medicine</topic><topic>Conduits</topic><topic>Confidence intervals</topic><topic>Coronary artery</topic><topic>Coronary Artery Bypass</topic><topic>Coronary Artery Disease - mortality</topic><topic>Coronary Artery Disease - pathology</topic><topic>Coronary Artery Disease - surgery</topic><topic>coronary revascularization</topic><topic>Coronary vessels</topic><topic>Data collection</topic><topic>Emergency procedures</topic><topic>Female</topic><topic>Grafting</topic><topic>Grafts</topic><topic>Health hazards</topic><topic>Heart attacks</topic><topic>Heart surgery</topic><topic>Humans</topic><topic>Identification methods</topic><topic>Intubation</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Myocardial infarction</topic><topic>off-pump coronary bypass surgery</topic><topic>on-pump coronary bypass surgery</topic><topic>Patients</topic><topic>Propensity Score</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Stroke</topic><topic>Surgeons</topic><topic>Survival</topic><topic>Survival Rate</topic><topic>Treatment Outcome</topic><topic>Variables</topic><topic>Vascular Patency</topic><topic>Vital statistics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chikwe, Joanna</creatorcontrib><creatorcontrib>Sun, Erick</creatorcontrib><creatorcontrib>Hannan, Edward L.</creatorcontrib><creatorcontrib>Itagaki, Shinobu</creatorcontrib><creatorcontrib>Lee, Timothy</creatorcontrib><creatorcontrib>Adams, David H.</creatorcontrib><creatorcontrib>Egorova, Natalia N.</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><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chikwe, Joanna</au><au>Sun, Erick</au><au>Hannan, Edward L.</au><au>Itagaki, Shinobu</au><au>Lee, Timothy</au><au>Adams, David H.</au><au>Egorova, Natalia N.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of Second Arterial Conduits in Patients Undergoing Multivessel Coronary Artery Bypass Graft Surgery</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2019-11-05</date><risdate>2019</risdate><volume>74</volume><issue>18</issue><spage>2238</spage><epage>2248</epage><pages>2238-2248</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><abstract>Benefits of multiarterial versus single-arterial coronary bypass grafting (CABG) are debated.
This study sought to compare long-term survival, morbidity, and graft patency after multiarterial versus single-arterial CABG.
Mandatory clinical registries linked with discharge databases were used to identify baseline and operative characteristics and outcomes of 42,714 patients undergoing CABG from 2005 through 2012. Patients with single-vessel disease, without arterial conduits, or undergoing emergency, reoperative, or concomitant procedures were excluded. Survival, stroke, myocardial infarction, and repeat revascularization rates were compared using Cox modeling, and patients were matched by propensity score. Median follow-up was 7.8 years (interquartile range: 5 to 10 years); last follow-up was December 31, 2016.
Of the 26,124 patients, 3,647 (14.0%) underwent multiarterial CABG. Single-arterial CABG patients were older (mean 68 vs. 61 years; p < 0.001), had more comorbidities, and received fewer bypass grafts (3.4 vs. 3.6; p < 0.001). After adjusting for baseline differences, multiarterial CABG was associated with lower 10-year mortality compared with single-arterial CABG in 3,588 propensity-matched pairs (15.1% vs. 17.3%; p = 0.01). Multiarterial CABG was associated with lower 10-year myocardial infarction (hazard ratio: 0.81; 95% confidence interval: 0.69 to 0.95) and lower 10-year reintervention rate (hazard ratio: 0.81; 95% confidence interval: 0.67 to 0.99).
In contemporary practice, single-arterial CABG is used in 85% of patients and is associated with increased long-term mortality, myocardial infarction, and reintervention compared with multiarterial CABG. Multiarterial CABG is underused in contemporary surgical revascularization, and targeted referral of younger patients for multiarterial revascularization may address this practice gap.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31672179</pmid><doi>10.1016/j.jacc.2019.08.1043</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0735-1097 |
| ispartof | Journal of the American College of Cardiology, 2019-11, Vol.74 (18), p.2238-2248 |
| issn | 0735-1097 1558-3597 |
| language | eng |
| recordid | cdi_proquest_journals_2309736316 |
| source | BACON - Elsevier - GLOBAL_SCIENCEDIRECT-OPENACCESS |
| subjects | Aged arterial graft Cardiology Cerebral infarction Clinical medicine Conduits Confidence intervals Coronary artery Coronary Artery Bypass Coronary Artery Disease - mortality Coronary Artery Disease - pathology Coronary Artery Disease - surgery coronary revascularization Coronary vessels Data collection Emergency procedures Female Grafting Grafts Health hazards Heart attacks Heart surgery Humans Identification methods Intubation Male Middle Aged Morbidity Mortality Myocardial infarction off-pump coronary bypass surgery on-pump coronary bypass surgery Patients Propensity Score Proportional Hazards Models Retrospective Studies Stroke Surgeons Survival Survival Rate Treatment Outcome Variables Vascular Patency Vital statistics |
| title | Outcomes of Second Arterial Conduits in Patients Undergoing Multivessel Coronary Artery Bypass Graft Surgery |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-28T17%3A18%3A34IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Outcomes%20of%20Second%20Arterial%20Conduits%20in%C2%A0Patients%20Undergoing%20Multivessel%20Coronary%20Artery%20Bypass%20Graft%20Surgery&rft.jtitle=Journal%20of%20the%20American%20College%20of%20Cardiology&rft.au=Chikwe,%20Joanna&rft.date=2019-11-05&rft.volume=74&rft.issue=18&rft.spage=2238&rft.epage=2248&rft.pages=2238-2248&rft.issn=0735-1097&rft.eissn=1558-3597&rft_id=info:doi/10.1016/j.jacc.2019.08.1043&rft_dat=%3Cproquest_cross%3E2309736316%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c399t-b4b4b84ef6382eaade757a392801687f14e3d75b74f0e04522d4cb3fd02a51c53%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2309736316&rft_id=info:pmid/31672179&rfr_iscdi=true |