Key result
Total arterial revascularization during CABG reduces late all-cause mortality ~22% vs saphenous vein grafts.
Why the study?
Saphenous vein grafts frequently develop progressive occlusion by 10 years, raising the question of whether avoiding them through total arterial revascularization leads to improved late survival.
Does total arterial revascularization (TAR) reduce late all-cause mortality in patients undergoing coronary bypass surgery compared to using saphenous vein grafts?
Meta-Analysis (n=127,565)
Does total arterial revascularization (TAR) reduce late all-cause mortality in patients undergoing coronary bypass surgery compared to using saphenous vein grafts?
Effect estimate: HR 0.78 (95% CI 0.72-0.85)
p-value: p=<0.001
Total arterial revascularization during coronary bypass surgery is associated with a significant reduction in late all-cause mortality compared to the use of saphenous vein grafts.
May support TAR preference in CABG for survival; extends observational data but leaves open RCT confirmation.
Approximately 95% of patients of any age undergoing contemporary, coronary bypass surgery will receive at least 1 saphenous vein graft (SVG). It is recognized that SVG will develop progressive and accelerated atherosclerosis, resulting in a stenosis, and in occlusion that occurs in 50% by 10 years postoperatively. For arterial conduits, there is little evidence of progressive failure as for SVG. Could avoidance of SVG (total arterial revascularization [TAR]) lead to a different late (>5 year) survival? A literature review of 23 studies (N = 100,314 matched patients) at a mean 8.8 years postoperative found reduced all-cause mortality for TAR (HR: 0.77; 95% CI: 0.71-0.84; P < 0.001). An expanded analysis with a new unpublished data set (N = 63,288 matched patients) was combined with the literature review (N = 127,565). It found reduced all-cause mortality for TAR (HR: 0.78; 95% CI: 0.72-0.85; P < 0.001). Additional Bayesian analysis found a very high probability of a TAR-associated reduction all-cause mortality.
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Royse et al. (2022) conducted a meta-analysis in Coronary artery disease requiring bypass surgery (n=127,565). Total arterial revascularization (TAR) vs. Saphenous vein grafting (SVG) was evaluated on All-cause mortality (HR 0.78, 95% CI 0.72-0.85, p=<0.001). Total arterial revascularization during coronary bypass surgery reduced late all-cause mortality compared to saphenous vein grafts (HR 0.78; 95% CI 0.72-0.85; P<0.001).
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