(Representative image of multiple arterial revascularization)
A Canadian study  published in JAMA Cardiology has shown lower long term mortality, repeat revascularization, myocardial infarction and heart failure in patients receiving multiple arterial grafts as compared to those single LIMA (left internal mammary artery) graft along with SVG (saphenous vein grafts). Of over twenty thousand patients with triple vessel or left main disease who underwent CABG (coronary artery bypass graft), about 5600 received multiple arterial grafts and around 14500 received LIMA graft along with SVG. Subgroup analyses showed that the benefits were consistent in those with diabetes mellitus, obesity, moderate left ventricular systolic dysfunction, COPD (chronic obstructive pulmonary disease), peripheral arterial disease and kidney disease. Additional benefit of multiple arterial grafting could not be demonstrated in the subgroup with severe left ventricular dysfunction. Median follow up period was 9.1 years, with an interquartile range of 5.1-12.6 years for those who received multiple arterial grafts. For those who received LIMA + SVG, it was 8.1 (4.5-11.7) years. Reduced mortality and repeat revascularization was demonstrated in a 15 year follow up while reduced myocardial infarction and heart failure was demonstrated in 7 year follow up.
Authors recommend consideration of multiple arterial revascularization for all suitable candidates undergoing CABG.
Though 30 day adverse events were similar in both groups, a higher incidence of sternal reconstruction at 180 days was noted in the multiple arterial revascularization group using RIMA + LIMA. But this was not seen in those receiving radial artery graft instead of RIMA.
- Pu A et al. Long-term Outcomes of Multiple Arterial Coronary Artery Bypass Grafting. A Population-Based Study of Patients in British Columbia, Canada. JAMA Cardiol. Published online October 11, 2017. doi:10.1001/jamacardio.2017.3705. [Free full text]]