Dayan Victor, Hernandez Maximiliano, Montero Juan Andres, Sosa Carolina, Cubas Santiago, Bakaeen Faisal
Centro Cardiovascular Universitario and Instituto Nacional de Cirugia Cardiaca, Hospital de Clinicas, Universidad de la Republica, Montevideo, Uruguay.
Instituto Nacional de Cirugia Cardiaca, Montevideo, Uruguay.
J Thorac Cardiovasc Surg. 2025 Jun 9. doi: 10.1016/j.jtcvs.2025.05.023.
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 = .035) and nonsmokers (HR, 0.78; 95% CI, 0.69-0.89; P < .001; P = .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.
冠状动脉旁路移植术（CABG）仍然是多支冠状动脉疾病的基石性治疗方法。虽然单支动脉血运重建一直是标准做法，但多支动脉移植（MAG）的使用与更好的长期预后相关。然而，其应用受到技术挑战和潜在并发症的限制。本研究评估了拉丁美洲最大且最长队列中MAG的预后情况。
这项回顾性队列研究利用了乌拉圭国家资源基金数据库，纳入了2002年至2022年间接受单纯CABG的21959例患者。采用倾向评分匹配法，根据23个术前变量创建可比组。主要结局是生存率；次要复合结局包括手术死亡率、中风、感染及其他术后并发症。使用Kaplan-Meier法和Cox回归分析生存率。
12.6%的病例采用了MAG。在未匹配队列中，MAG组的复合结局发生率显著更低（5.9%对7.7%；P < .001），而在倾向评分匹配队列中未发现差异。在匹配队列（n = 5522）中，MAG与生存率提高相关（风险比[HR]，0.88；95%置信区间[CI]，0.79 - 0.97；P = .013）。年龄<70岁的患者（HR，0.83；95% CI，0.74 - 0.93；P = .001；P = .035）和非吸烟者（HR，0.78；95% CI，0.69 - 0.89；P < .001；P = .024）接受MAG时生存率更高。MAG与术后中风风险降低（比值比，0.56；95% CI，0.32 - 0.98）及通气时间延长相关。
本研究强调了CABG中MAG与更长生存期的关联。这种关联主要见于年轻患者（<70岁）和非吸烟者。这些发现强化了更广泛采用MAG的必要性，尤其是在资源有限地区，以优化患者预后。进一步研究应解决实施障碍和技术熟练度问题。
