Single versus multiple arterial coronary artery bypass grafting in men and women: results from Polish National Registry of Cardiac Surgery Procedures

Abstract

Background: The objective of this multicenter study aimed to investigate the impact of sex on long-term survival among patients with multivessel coronary artery disease undergoing coronary artery bypass grafting (CABG) using multiple arterial grafting (MAG) or a single artery with saphenous vein grafts.

Materials and methods: Data were obtained from the Polish National Registry of Cardiac Surgery Procedures database. This study included 81 136 patients who underwent CABG for multivessel disease between January 2012 and December 2020 (22.9 were women and 77.1% were men). MAG was performed in 8.3 and 11.7% of female and male patients, respectively. A 1:1 propensity score (PS)-matching was performed. Long-term mortality was compared between matched groups of men and women. Subgroup analyses of patients aged <70 and ≥70 years, with an ejection fraction (EF) >40% and ≤40%, and with and without diabetes, obesity, peripheral artery disease (PAD), or chronic lung disease (CLD) were performed separately in women and men.

Results: MAG was associated with lower long-term mortality than saphenous vein grafts in 1528 PS-matched female pairs [hazard ratio (HR): 0.74; 95% CI: 0.59-0.92; P =0.007) and 7283 PS-matched male pairs (HR: 0.80; 95% CI: 0.72-0.88; P <0.001). Subgroup analyses confirmed the results among female patients aged <70 years, with diabetes and EF >40%, and without PAD or CLD, and of male patients aged <70 and ≥70 years; with EF >40%; with or without diabetes, obesity, or PAD; and without CLD.

Conclusions: In patients undergoing CABG, MAG was associated with significantly improved survival in both sexes. The long-term benefits of MAG observed across subgroups of men and women support the consideration of a multiarterial revascularization strategy for a broader spectrum of patients.

Figure 1

Flow diagram detailing selection of patients within each group. The diagram presents included and excluded patients as well as number of patients before and after propensity score matching. CABG, coronary artery bypass grafting; MAG, multiarterial graft; SAG, single arterial graft with veins.

Figure 2

Risk of mortality in women and men who underwent multiple arterial graft (MAG) versus single arterial graft (SAG) in the propensity score matched patients and in the propensity matched subgroup of patients younger than age 70 years and aged 70 years or older, diabetic and non diabetic patients, obese and nonobese patients, ejection-fraction (EF) above 40% and equal or below 40%, with and without peripheral artery disease (PAD), and with and without chronic lung disease (CLD), separately in women and men.

Figure 3

Kaplan–Meier survival curve probabilities after propensity score weighting in women (A) and in men (B). MAG, multiarterial grafts, SAG, single artery+saphenous vein graft.