Long-term outcomes of patients undergoing multiarterial grafting in coronary artery bypass grafting: Insights from a Latin American national cohort.

Abstract

Coronary artery bypass grafting (CABG) remains a cornerstone treatment for multivessel coronary artery disease. While single-artery revascularization has been the standard, the use of multiarterial grafting (MAG) is associated with superior long-term outcomes. However, its adoption is limited by technical challenges and potential complications. This study evaluates outcomes of MAG in the largest and longest cohort from Latin America. This retrospective cohort study drew on Uruguay's National Resources Fund database, encompassing 21,959 patients who underwent isolated CABG between 2002 and 2022. Propensity score matching was used to create comparable groups based on 23 pretreatment variables. The primary outcome was survival; secondary composite outcome included operative mortality, stroke, infections, and other postoperative complications. Survival was analyzed using Kaplan-Meier and Cox regression. MAG was performed in 12.6% of cases. The incidence of the composite outcome was significantly lower in the MAG group in the unmatched cohort (5.9% vs 7.7%; P < .001), whereas no differences were found in the propensity score-matched cohort. In the matched cohort (n = 5522), MAG was associated with improved survival (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.79-0.97; P = .013). Patients age <70 years (HR, 0.83; 95% CI, 0.74-0.93; P = .001; P_int = .035) and nonsmokers (HR, 0.78; 95% CI, 0.69-0.89; P < .001; P_int = .024) had better survival with MAG. MAG was associated with reduced risk of postoperative stroke (odds ratio, 0.56; 95% CI, 0.32-0.98) and prolonged ventilation. This study highlights the association of longer survival with MAG in CABG. This association was seen mainly in younger patients (<70 years) and nonsmokers. These findings reinforce the need for broader adoption of MAG, especially in resource-limited settings, to optimize patient outcomes. Further research should address barriers to implementation and technical proficiency.