Key result
Statewide QI initiative linked to ~35-point increase in multiarterial coronary grafting utilization.
Why the study?
The impact of a statewide quality improvement initiative to increase multiarterial bypass grafting, particularly among elderly and female patients, needed evaluation.
Does a statewide quality improvement initiative increase multiarterial bypass grafting utilization overall and in elderly and female patients undergoing isolated CABG without increasing operative mortality or major morbidity?
Cohort (n=51,739)
Yes
Does a statewide quality improvement initiative increase multiarterial bypass grafting utilization overall and in elderly and female patients undergoing isolated CABG without increasing operative mortality or major morbidity?
A statewide quality improvement initiative safely and significantly increased multiarterial coronary bypass grafting overall and in women and the elderly, though lower utilization persisted in these subgroups.
Answers are grounded in this paper and cite their sources.
May support expanded multiarterial grafting in elderly and women; leaves open causes of persistent disparities despite comparable safety.
This study evaluated the impact of the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative initiative to increase multiarterial bypass grafting, focusing on elderly and female patients. Adults undergoing isolated, coronary artery bypass grafting with a left internal thoracic artery and >1 additional graft were included in the analysis (2014-2025). Patients were classified as single-arterial or multiarterial grafting (>2 arterial coronary anastomoses) including bilateral internal thoracic artery or internal thoracic artery with radial artery. Primary outcomes included multiarterial grafting utilization overall and within elderly (≥70 years) and female patients. Secondary outcomes included STS risk-adjusted, recalibrated observed-to-expected ratios for 30-day or operative mortality and major morbidity/mortality. Of 51,739 patients, 11,705 (22.6%) underwent multi-arterial grafting of whom 2836 (24.2%) were elderly and 1896 (16.2%) were female. Multiarterial grafting increased over-time (2014:7.5%; 2024: 42.8%, p < .001), driven largely by the use of radial artery (2014: 5.7% vs 2024: 33.7%, p value < .001]. Utilization remained lower among female and the elderly, reaching only 32% (n = 302) and 26.8% (n = 482) in 2024, respectively. Recalibrated observed-to-expected ratios for mortality and major morbidity/mortality were similar between single arterial and any multiarterial grafting, while they were lower than expected for the radial artery group. This statewide quality improvement initiative was associated with a safe increase in multiarterial grafting overall, and among the elderly and women; however, disparities persisted in these groups. These findings highlight the need for targeted initiatives to further expand the adoption of multiarterial grafting.
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Caruso et al. (2026) conducted a cohort in Coronary artery disease requiring isolated coronary artery bypass grafting (n=51,739). Multiarterial bypass grafting (>2 arterial coronary anastomoses, including bilateral internal thoracic artery or internal thoracic artery with radial artery) vs. Single-arterial grafting was evaluated on Multiarterial grafting utilization overall and within elderly (≥70 years) and female patients (p=<0.001). A statewide quality improvement initiative increased multiarterial grafting utilization from 7.5% in 2014 to 42.8% in 2024, reaching 32% in women and 26.8% in elderly patients.
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