Total arterial revascularization is safe: Multicenter ten-year analysis of 71,470 coronary procedures

Background. The purpose of this study was to assess the use of arterial revascularization and to compare the in-hospital mortality with other CABG grafting strategies. Methods. A total of 71,470 CABG patients (1992-2001) in 27 centers in the United Kingdom were studied. The proportion of patients with arterial revascularization was compared. In-hospital mortality was compared for various grafting strategies: all-arterial (n=5,401), all non-all-arterial patients (n=66,069), one artery any number of veins (n=49,801). The groups were compared for in-hospital mortality using multivariate logistic regression to assess the independent effect of the grafting strategies on mortality; logistic EuroSCORE-predicted mortality was compared to actual mortality, and all arterial and one artery and veins patients were compared with propensity score analysis. Results. There was a significant increase in the proportion of all-arterial patients over time (3.2% to 11.7%, p<0.001) with evidence of variability across centers. Crude mortality for all-arterial patients was 2% vs 3% for all non-all-arterial patients (p<0.001). In multivariate analysis, all-arterial was associated with a slight but insignificant increase in in-hospital mortality (odds ratio [OR] 1.13; [95% confidence interval {CI} 0.86-1.48], p=0.36). There was a trend toward higher mortality in the all-arterial group when compared with the one artery and veins group (OR 1.19 [95% CI 0.91-1.56], p=0.10). The one artery and veins group was the only group where actual mortality was significantly lower than predicted by EuroSCORE (p<0.001). In propensity analysis the mortality was 1.51% for one artery and veins and 1.74% of all-arterial patients (p=0.56). Conclusions. The use of arterial grafting has increased over time, varies by center, and appears to be safe in terms of in-hospital mortality.