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31st Annual Meeting Abstracts: How Many Arterial Grafts Are Enough: A Population Based Study of Mid-term Outcomes
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4. How Many Arterial Grafts Are Enough: A Population Based Study of Mid-term Outcomes
V. Guru, S. E. Fremes, J. V. Tu. Institute For Clinical Evaluative Sciences, Toronto, ON, Canada,
BACKGROUND: Evidence suggests that two arterial grafts provide improved outcome as compared to one. This study understands the mid-term outcomes of patients receiving one, two, or three arterial grafts.
METHODS: This is a retrospective population based cohort of 64,222 patients (47,214 one arterial graft-ONE, 5,466 two arterial grafts-TWO, 1,047 three arterial grafts-THREE) undergoing isolated CABG in Ontario (1991-2001) using clinical and administrative data with complete follow-up until Dec.2002 (average patient years follow-up:5.1yrs-ONE, 3.9yrs-TWO, 2.7yrs-THREE). Propensity matching was used to compare outcomes between ONE vs TWO, and TWO vs THREE groups. The outcomes included: death, repeat revascularization (REVASC:angioplasty, CABG), cardiac readmission (READM: UA, CHF, MI). Cox proportional hazards analysis was conducted for propensity matched patients.
RESULTS: The use of multiple arterial grafts increased over the study time period (Figure.1). 5010 TWO patients were propensity matched to ONE. 991 ONE patients were propensity matched to TWO patients. The Cox hazard ratios of propensity matched patients are listed in Table-1.
CONCLUSIONS: There is no mid-term outcome benefit with three arterial grafts. Patients with two arterial grafts had lower rates of cardiac readmission versus those with one arterial graft. This suggests patients should routinely receive at least two arterial bypasses for optimal mid-term outcomes.
Table 1. Cox Hazards Ratios of Propensity Matched CABG Patients in Ontario | Outcome | TWO vs ONE arterial grafts (95% C.I.) | THREE vs TWO arterial grafts (95% C.I.) | | Death | 0.9 (0.77-1.15) | 1.0 (0.56-1.78) | | REVASC | 1.0 (0.82-1.13) | 1.3 (0.91-2.13) | | READM | 0.8 (0.69-0.85) | 0.9 (0.57-1.22) | | Composite | 0.8 (0.73-0.89) | 1.0 (0.74-1.28) |
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