Abstract
Background
Coronary artery bypass grafting (CABG) is one of the revascularization modalities
available in patients with left ventricular dysfunction (LVD). Multiple arterial grafting
(MAG) is associated with improved long-term outcomes. Data on the benefits of MAG
in patients with LVD are limited. We examined the effect of MAG on outcomes across
the spectrum of left ventricle (LV) function.
Methods
Retrospective cohort study of patients undergoing isolated CABG (January 1, 2009,
to October 1, 2021). Patients were grouped according to revascularization strategy
(single vs. MAG). The primary outcome was a composite of all-cause mortality, cerebrovascular
accident, myocardial infarction, and repeat revascularization (major adverse cardiac
and cerebrovascular events [MACCE]). The cumulative incidence of MACCE was plotted
using Kaplan–Meier curves. Results were stratified according to LV function (<30%,
30–50%, >50%).
Results
Our cohort included 4,763 patients; 1,976 (41.4%) underwent single arterial grafting
(SAG), and 2,787 (58.6%) underwent MAG; 3,976 (83.4%) were male with a median age
of 64 (interquartile range [IQR] 57–71) years. Distribution of LV function was 2,539
(53.3%) with an ejection fraction (EF) >50%, 1,828 (38.3%) with an EF of 30–50%, and
396 (8.3%) with an EF <30%. Median follow-up time was 64 (37–102) months. Cumulative
incidence of MACCE at 72 months was 28.7% in the MAG and 30.3% in the SAG group. Stratified
by LV function, the hazard ratio for MACCE at 160 months was 0.71 (95% CI 0.54–0.93),
0.78 (95% CI 0.68–0.9), and 0.95 (95% CI 0.83–1.09) for LV function <30%, 30–50%,
>50%, respectively, with no significant interaction between MAG and LV function.
Conclusion
MAG is associated with improved outcomes following CABG across the spectrum of LV
function.
Keywords
multiarterial grafting - coronary artery bypass grafting - left ventricular dysfunction
