Long-term survival after coronary bypass surgery with multiple versus single arterial grafts

the SYNTAX Extended Survival Investigators; D. J. F. M. Thuijs; P. Davierwala; M. Milojevic; S. V. Deo; T. Noack; A. P. Kappetein; P. W. Serruys; F. W. Mohr; M. C. Morice; M. J. Mack; L. E. G. E. Ståhle; N. J. Verberkmoes; D. R. Holmes; S. J. Head

doi:10.1093/ejcts/ezab392

Long-term survival after coronary bypass surgery with multiple versus single arterial grafts

the SYNTAX Extended Survival Investigators, D. J. F. M. Thuijs^*, P. Davierwala, M. Milojevic, S. V. Deo, T. Noack, A. P. Kappetein, P. W. Serruys, F. W. Mohr, M. C. Morice, M. J. Mack, L. E. G. E. Ståhle, N. J. Verberkmoes, D. R. Holmes, S. J. Head

^*Corresponding author for this work

Cardiothoracic Surgery

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Abstract

OBJECTIVES: This study sought to evaluate the long-term differences in survival between multiple arterial grafts (MAG) and single arterial grafts (SAG) in patients who underwent coronary artery bypass grafting (CABG) in the SYNTAX study. METHODS: The present analysis included the randomized and registry-treated CABG patients (n = 1509) from the SYNTAX Extended Survival study (SYNTAXES). Patients with only venous (n = 42) or synthetic grafts (n = 1) were excluded. The primary end point was all-cause death at the longest follow-up. Multivariable Cox regression was used to adjust for differences in baseline characteristics. Sensitivity analysis using propensity matching with inverse probability for treatment weights was performed. RESULTS: Of the 1466 included patients, 465 (31.7%) received MAG and 1001 (68.3%) SAG. Patients receiving MAG were younger and at lower risk. At the longest follow-up of 12.6 years, all-cause death occurred in 23.6% of MAG and 40.0% of SAG patients [adjusted hazard ratio (HR) 0.74, 95% confidence interval (CI) (0.55-0.98); P = 0.038], which was confirmed by sensitivity analysis. MAG in patients with the three-vessel disease was associated with significant lower unadjusted and adjusted all-cause death at 12.6 years [adjusted HR 0.65, 95% CI (0.44-0.97); P = 0.033]. In contrast, no significance was observed after risk adjustment in patients with the left main disease, with and without diabetes, or among SYNTAX score tertiles. CONCLUSIONS: In the present post hoc analysis of all-comers patients from the SYNTAX trial, MAG resulted in markedly lower all-cause death at 12.6-year follow-up compared to a SAG strategy. Hence, this striking long-term survival benefit of MAG over SAG encourages more extensive use of multiple arterial grafting in selected patients with reasonable life expectancy. Trial registration: SYNTAXES ClinicalTrials.gov reference: NCT03417050; SYNTAX ClinicalTrials.gov reference: NCT00114972.

Original language	English
Pages (from-to)	925-933
Number of pages	9
Journal	European Journal of Cardio-thoracic Surgery
Volume	61
Issue number	4
DOIs	https://doi.org/10.1093/ejcts/ezab392
Publication status	Published - 1 Apr 2022

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Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.

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the SYNTAX Extended Survival Investigators, Thuijs, D. J. F. M., Davierwala, P., Milojevic, M., Deo, S. V., Noack, T., Kappetein, A. P., Serruys, P. W., Mohr, F. W., Morice, M. C., Mack, M. J., Ståhle, L. E. G. E., Verberkmoes, N. J., Holmes, D. R., & Head, S. J. (2022). Long-term survival after coronary bypass surgery with multiple versus single arterial grafts. European Journal of Cardio-thoracic Surgery, 61(4), 925-933. https://doi.org/10.1093/ejcts/ezab392

@article{8e56373c6a064bf5a0e9c9d2eea96de1,

title = "Long-term survival after coronary bypass surgery with multiple versus single arterial grafts",

abstract = "OBJECTIVES: This study sought to evaluate the long-term differences in survival between multiple arterial grafts (MAG) and single arterial grafts (SAG) in patients who underwent coronary artery bypass grafting (CABG) in the SYNTAX study. METHODS: The present analysis included the randomized and registry-treated CABG patients (n = 1509) from the SYNTAX Extended Survival study (SYNTAXES). Patients with only venous (n = 42) or synthetic grafts (n = 1) were excluded. The primary end point was all-cause death at the longest follow-up. Multivariable Cox regression was used to adjust for differences in baseline characteristics. Sensitivity analysis using propensity matching with inverse probability for treatment weights was performed. RESULTS: Of the 1466 included patients, 465 (31.7%) received MAG and 1001 (68.3%) SAG. Patients receiving MAG were younger and at lower risk. At the longest follow-up of 12.6 years, all-cause death occurred in 23.6% of MAG and 40.0% of SAG patients [adjusted hazard ratio (HR) 0.74, 95% confidence interval (CI) (0.55-0.98); P = 0.038], which was confirmed by sensitivity analysis. MAG in patients with the three-vessel disease was associated with significant lower unadjusted and adjusted all-cause death at 12.6 years [adjusted HR 0.65, 95% CI (0.44-0.97); P = 0.033]. In contrast, no significance was observed after risk adjustment in patients with the left main disease, with and without diabetes, or among SYNTAX score tertiles. CONCLUSIONS: In the present post hoc analysis of all-comers patients from the SYNTAX trial, MAG resulted in markedly lower all-cause death at 12.6-year follow-up compared to a SAG strategy. Hence, this striking long-term survival benefit of MAG over SAG encourages more extensive use of multiple arterial grafting in selected patients with reasonable life expectancy. Trial registration: SYNTAXES ClinicalTrials.gov reference: NCT03417050; SYNTAX ClinicalTrials.gov reference: NCT00114972.",

author = "{the SYNTAX Extended Survival Investigators} and Thuijs, {D. J. F. M.} and P. Davierwala and M. Milojevic and Deo, {S. V.} and T. Noack and Kappetein, {A. P.} and Serruys, {P. W.} and Mohr, {F. W.} and Morice, {M. C.} and Mack, {M. J.} and St{\aa}hle, {L. E. G. E.} and Verberkmoes, {N. J.} and Holmes, {D. R.} and Head, {S. J.}",

note = "Publisher Copyright: {\textcopyright} 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.",

year = "2022",

month = apr,

day = "1",

doi = "10.1093/ejcts/ezab392",

language = "English",

volume = "61",

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journal = "European Journal of Cardio-thoracic Surgery",

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the SYNTAX Extended Survival Investigators, Thuijs, DJFM, Davierwala, P, Milojevic, M, Deo, SV, Noack, T, Kappetein, AP, Serruys, PW, Mohr, FW, Morice, MC, Mack, MJ, Ståhle, LEGE, Verberkmoes, NJ, Holmes, DR & Head, SJ 2022, 'Long-term survival after coronary bypass surgery with multiple versus single arterial grafts', European Journal of Cardio-thoracic Surgery, vol. 61, no. 4, pp. 925-933. https://doi.org/10.1093/ejcts/ezab392

TY - JOUR

T1 - Long-term survival after coronary bypass surgery with multiple versus single arterial grafts

AU - the SYNTAX Extended Survival Investigators

AU - Thuijs, D. J. F. M.

AU - Davierwala, P.

AU - Milojevic, M.

AU - Deo, S. V.

AU - Noack, T.

AU - Kappetein, A. P.

AU - Serruys, P. W.

AU - Mohr, F. W.

AU - Morice, M. C.

AU - Mack, M. J.

AU - Ståhle, L. E. G. E.

AU - Verberkmoes, N. J.

AU - Holmes, D. R.

AU - Head, S. J.

PY - 2022/4/1

Y1 - 2022/4/1

N2 - OBJECTIVES: This study sought to evaluate the long-term differences in survival between multiple arterial grafts (MAG) and single arterial grafts (SAG) in patients who underwent coronary artery bypass grafting (CABG) in the SYNTAX study. METHODS: The present analysis included the randomized and registry-treated CABG patients (n = 1509) from the SYNTAX Extended Survival study (SYNTAXES). Patients with only venous (n = 42) or synthetic grafts (n = 1) were excluded. The primary end point was all-cause death at the longest follow-up. Multivariable Cox regression was used to adjust for differences in baseline characteristics. Sensitivity analysis using propensity matching with inverse probability for treatment weights was performed. RESULTS: Of the 1466 included patients, 465 (31.7%) received MAG and 1001 (68.3%) SAG. Patients receiving MAG were younger and at lower risk. At the longest follow-up of 12.6 years, all-cause death occurred in 23.6% of MAG and 40.0% of SAG patients [adjusted hazard ratio (HR) 0.74, 95% confidence interval (CI) (0.55-0.98); P = 0.038], which was confirmed by sensitivity analysis. MAG in patients with the three-vessel disease was associated with significant lower unadjusted and adjusted all-cause death at 12.6 years [adjusted HR 0.65, 95% CI (0.44-0.97); P = 0.033]. In contrast, no significance was observed after risk adjustment in patients with the left main disease, with and without diabetes, or among SYNTAX score tertiles. CONCLUSIONS: In the present post hoc analysis of all-comers patients from the SYNTAX trial, MAG resulted in markedly lower all-cause death at 12.6-year follow-up compared to a SAG strategy. Hence, this striking long-term survival benefit of MAG over SAG encourages more extensive use of multiple arterial grafting in selected patients with reasonable life expectancy. Trial registration: SYNTAXES ClinicalTrials.gov reference: NCT03417050; SYNTAX ClinicalTrials.gov reference: NCT00114972.

AB - OBJECTIVES: This study sought to evaluate the long-term differences in survival between multiple arterial grafts (MAG) and single arterial grafts (SAG) in patients who underwent coronary artery bypass grafting (CABG) in the SYNTAX study. METHODS: The present analysis included the randomized and registry-treated CABG patients (n = 1509) from the SYNTAX Extended Survival study (SYNTAXES). Patients with only venous (n = 42) or synthetic grafts (n = 1) were excluded. The primary end point was all-cause death at the longest follow-up. Multivariable Cox regression was used to adjust for differences in baseline characteristics. Sensitivity analysis using propensity matching with inverse probability for treatment weights was performed. RESULTS: Of the 1466 included patients, 465 (31.7%) received MAG and 1001 (68.3%) SAG. Patients receiving MAG were younger and at lower risk. At the longest follow-up of 12.6 years, all-cause death occurred in 23.6% of MAG and 40.0% of SAG patients [adjusted hazard ratio (HR) 0.74, 95% confidence interval (CI) (0.55-0.98); P = 0.038], which was confirmed by sensitivity analysis. MAG in patients with the three-vessel disease was associated with significant lower unadjusted and adjusted all-cause death at 12.6 years [adjusted HR 0.65, 95% CI (0.44-0.97); P = 0.033]. In contrast, no significance was observed after risk adjustment in patients with the left main disease, with and without diabetes, or among SYNTAX score tertiles. CONCLUSIONS: In the present post hoc analysis of all-comers patients from the SYNTAX trial, MAG resulted in markedly lower all-cause death at 12.6-year follow-up compared to a SAG strategy. Hence, this striking long-term survival benefit of MAG over SAG encourages more extensive use of multiple arterial grafting in selected patients with reasonable life expectancy. Trial registration: SYNTAXES ClinicalTrials.gov reference: NCT03417050; SYNTAX ClinicalTrials.gov reference: NCT00114972.

UR - http://www.scopus.com/inward/record.url?scp=85127917571&partnerID=8YFLogxK

U2 - 10.1093/ejcts/ezab392

DO - 10.1093/ejcts/ezab392

M3 - Article

C2 - 34618017

SN - 1010-7940

VL - 61

SP - 925

EP - 933

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

IS - 4

ER -

Long-term survival after coronary bypass surgery with multiple versus single arterial grafts

Abstract

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