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. 2025 Mar 27:12:1555242.
doi: 10.3389/fcvm.2025.1555242. eCollection 2025.

Comparison of multiple arterial grafts vs. single arterial graft in coronary artery bypass surgery: a systematic review and meta-analysis

Qiuju Ding #  1 , Qingqing Zhu #  1 , Lichong Lu  1 , Xiaofeng Cheng  1   2 , Min Ge  1
Affiliations

Comparison of multiple arterial grafts vs. single arterial graft in coronary artery bypass surgery: a systematic review and meta-analysis

Qiuju Ding et al. Front Cardiovasc Med. .

Abstract

Observational studies and randomised controlled trials (RCTs) have yielded conflicting results regarding the outcomes of multiple arterial grafts (MAG) vs. single arterial grafts (SAG) in coronary artery bypass graft (CABG) surgery. We conducted a comprehensive search across multiple databases for RCTs that directly compared MAG and SAG. The clinical outcomes assessed included all-cause mortality, cardiac-specific mortality, myocardial infarction (MI), repeat revascularization, stroke, sternal wound complications, and major bleeding. Outcomes were measured using hazard ratios (HR), relative risks (RR), and the corresponding 95% confidence intervals (CI). Eighteen RCTs involving 10,143 patients were included in the analysis. The follow-up period ranged from 6 months to 12.6 years, and the average age of the patients across the studies ranged between 56.3 and 77.3 years. MAG and SAG did not differ significantly in terms of the incidence of sternal wound complications, major bleeding, or stroke following CABG. However, the MAG group demonstrated a lower risk of all-cause mortality, cardiac mortality, MI, and repeat revascularization compared with the SAG group. MAG was associated with higher survival, lower risk of MI, and fewer repeat revascularization. Nonetheless, there were no significant differences in the incidence of sternal wound infections, major bleeding, and stroke between MAG and SAG.

Keywords: coronary artery bypass graft (CABG); multiple arterial graft (MAG); randomized controlled trials (RCTs); single arterial graft (SAG); survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart for study selection.
Figure 2
Figure 2
Forrest plot for all-cause mortality using intention-to-treat data. Horizontal lines represent 95% confidence intervals (CI). The rectangles represent the point estimate. The diamond represents the summary estimate (size of the diamond = 95% CI). The vertical line represents the reference of no increased risk.
Figure 3
Figure 3
Forrest plot for cardiac mortality using intention-to-treat data.
Figure 4
Figure 4
Forrest plot for myocardial infarction using intention-to-treat data.
Figure 5
Figure 5
Forrest plot for repeat revascularization using intention-to-treat data.
Figure 6
Figure 6
Forrest plot for sternal wound complications using intention-to-treat data.
See this image and copyright information in PMC

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