#VisualAbstract: Long-term Outcomes Associated With Total Arterial Revascularization vs Non–Total Arterial Revascularization

1. Total arterial vascularization (TAR) resulted in reduced likelihood of myocardial infarction, major cardio- and cerebrovascular events, and death compared to non-TAR in those requiring coronary artery bypass grafting.

Evidence Rating Level: 2 (Good)

Given the discussion surrounding multivessel coronary artery disease and the ideal conduits for coronary artery bypass grafting (CABG), there is a need to evaluate the long-term outcomes of total arterial revascularization (TAR) and non-TAR procedures, with non-TAR being CABG with at least one saphenous and one arterial vein graft. This multicenter, Canadian, population-based cohort study sought to investigate these clinical outcomes in primary isolated CABG with at least one arterial graft with a mean follow-up of 2.6 years (maximum follow-up 9.0 years). A total of 49,404 individuals with primary isolated CABG were identified (M [SD] age, 61.2 [10.4] years, 18.5% female), 4.9% of whom received TAR with total number of bypasses being 2 (62.5%), 3 (35.6%), or ≥4 (1.9%). Propensity score matching was used, resulting in 2,132 patient pairs with equivalent bypasses (mean [SD], 2.4 [0.5]) but a greater number of arterial grafts in the TAR group (mean difference 1.2, p<0.01). Deaths during hospitalization did not differ between the TAR (0.7%) and non-TAR groups (1.0%). Over the course of eight years, TAR was associated with attenuation of risk from major cerebro- and cardiovascular events (HR, 0.78, 95% CI 0.68 to 0.89), myocardial infarction (HR, 0.69, 95% CI 0.51 to 0.92), and death (HR, 0.80, 95% CI 0.66 to 0.97). Thus, this study suggests that TAR may be a wise clinical judgment among individuals who present with minimal risk factors and require CABG.

Click to read the study in JAMA Cardiology

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