April 21, 2026European Heart Journal31 citations
Single versus multiple arterial grafting in diabetic patients at 10 years: the Arterial Revascularization Trial
View Full Paper
Key Result
Multiple arterial grafting during coronary bypass was associated with substantially lower 10-year mortality in diabetic patients, despite a higher risk of deep sternal wound infection.
Key Points
- This analysis aims to evaluate the long-term effects of multiple versus single arterial grafting on mortality and major cardiac events in diabetic patients.
- Post hoc analysis of the Arterial Revascularization Trial including 3020 patients, with 716 having diabetes mellitus.
- Patients were stratified by diabetes status and grafting strategy (multiple arterial grafting vs. single arterial grafting).
- Primary endpoint was all-cause mortality; secondary endpoint was composite of major adverse cardiac events at 10 years.
- Multiple arterial grafting (MAG) was associated with lower 10-year mortality in diabetic patients (21.5% vs. 29.9%, adjusted HR 0.65, 95% CI 0.48-0.89).
- MAG also resulted in lower rates of 10-year major adverse cardiac events compared to single arterial grafting (SAG) for both non-diabetic and diabetic patients.
- Deep sternal wound infections were more common in the MAG group, especially among insulin-treated diabetic patients (9.6% vs. 6.3% for SAG).
Structured PICO
Does multiple arterial grafting reduce mortality at 10 years in diabetic patients undergoing coronary artery bypass grafting compared to single arterial grafting?
P
Population
Diabetic patients undergoing coronary artery bypass grafting (CABG)
I
Intervention
Multiple arterial grafting (MAG)
C
Comparator
Single arterial grafting
O
Outcome
Mortality at 10 yearshard clinical
In diabetic patients undergoing CABG, multiple arterial grafting is associated with lower 10-year mortality but a higher risk of deep sternal wound infection compared to single arterial grafting.
Main Result
Absolute Event Rate: 0% vs 0%
Abstract
AIMS: To evaluate the impact of multiple arterial grafting (MAG) vs. single arterial grafting (SAG) in a post hoc analysis of 10-year outcomes in patients with diabetes mellitus (DM) from the Arterial Revascularization Trial (ART). METHODS AND RESULTS: The primary endpoint was all-cause mortality and the secondary endpoint was a composite of major adverse cardiac events (MACE) at 10-year follow-up. Patients were stratified by diabetes status (non-DM and DM) and grafting strategy (MAG vs. SAG). A total of 3020 patients were included in the analysis; 716 (23.7%) had DM. Overall, 55.8% non-DM patients received MAG and 44.2% received SAG, while 56.6% DM patients received MAG and 43.4% received SAG. The use of MAG compared with SAG was associated with lower 10-year mortality for both non-DM 17.7 vs. 21.0%, adjusted hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.72-1.06 and DM patients (21.5 vs. 29.9%, adjusted HR 0.65, 95% CI 0.48-0.89; P for interaction = 0.12). For both groups, the rate of 10-year MACE was also lower for MAG vs. SAG. Overall, deep sternal wound infections (DSWIs) were uncommon but more frequent in the MAG vs. SAG group in both non-DM (3.3 vs. 2.1%) and DM patients (7.9 vs. 4.8%). The highest rates of DSWI were in insulin-treated patients receiving MAG (9.6 vs. 6.3%, when compared with SAG). CONCLUSION: In this post hoc analysis of the ART, MAG was associated with substantially lower mortality rates at 10 years after coronary artery bypass grafting in patients with DM. Patients with DM receiving MAG had a higher incidence of DSWI, especially if insulin dependent.
Expert Takes2 quotes
1/2
“We've always believed that patients with diabetes have more-severe coronary artery disease and therefore the potential of arteries to be of greater benefit would be intuitive. Of course, the patients were clearly not randomized to diabetes or not. But when we looked at the outcomes, we saw that overall, the use of multiple arterial grafts is beneficial in all patients, but the effect was even greater in patients with diabetes. And that would be intuitive in the sense that patients with diabetes tend to have more-generalized endothelial dysfunction and usually have more-severe coronary artery disease.”