Introduction: Coronary artery bypass grafting (CABG) remains a cornerstone treatment for multivessel coronary artery disease (CAD). While single-arterial revascularization has been the standard, multi-arterial grafts (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.
Methods: This retrospective cohort study utilized Uruguay's National Resources Fund database, encompassing 21,959 patients who underwent isolated CABG (2002-2022). Propensity score matching (PSM) was employed to create comparable groups based on 23 pre-treatment variables. 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.
Results: MAG was performed in 12.6% of cases. Composite outcome was significantly lower in the MAG group (5.9% vs 7.7%, p<0.001) in the un-matched cohort while no differences were found in the matched cohort. In the matched cohort (n=5,522), MAG was associated with improved survival (HR=0.88; 95% CI: 0.79-0.97; p=0.013). Patients <70 years old (HR = 0.83; 95%CI: 0.74, 0.93. p= 0.001. pint=0.035) and non-smokers (HR = 0.78; 95%CI: 0.69, 0.89. p< 0.001. pint= 0.024) had better survival with MAG. MAG showed reduced risks of postoperative stroke (OR=0.56; 95% CI: 0.32-0.98) and prolonged ventilation.
Conclusion: This study highlights the association of longer survival of MAG in CABG. This association was seen mainly in younger patients (<70 years old) and non-smokers. 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.
Keywords: CABG; diabetes; multi-arterial revascularization.
Copyright © 2025. Published by Elsevier Inc.
