@article{5706c4f00c494242ac3766a04a868de7,
title = "Multiple Versus Single Arterial Coronary Arterial Bypass Grafting Surgery for Multivessel Disease in Atrial Fibrillation",
abstract = "Observational studies suggest improved outcomes with multiple (MAG) as compared to single arterial grafting (SAG) in patients with multivessel coronary artery disease and undergoing coronary artery bypass grafting (CABG). Even though around 6% of CABG patients have preoperative atrial fibrillation, previous studies did not address MAG versus SAG comparison in this setting. Data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. 5738 patients with multivessel coronary artery disease and AF (77.9% men, mean age 69.0 ± 8.0) undergoing isolated CABG surgery between 2006 and 2019 in 37 reference centers across Poland were analyzed. Propensity score matching was performed. Primary endpoint was mid-term survival. Median follow-up was 5 years ([IQR 1.9-7.6], max.13). One-to-three Propensity score matching included 2364 patients divided into MAG (591) and SAG (1773) subsets. Subjects were no different in terms of baseline risk and surgical characteristics. Number of distal anastomoses was 2.82 ± 0.83 versus 2.80 ± 0.75 (P = 0.516) for MAG and SAG, respectively. In-hospital outcomes and mortality risk at 1-year (hazard ratio, 95% confidence intervals: 1.13 [0.81-1.58]; P = 0.469) was unchanged with MAG. Multiple arterial grafting was associated with 20% improved mid-term survival: HR 0.80; (95% confidence intervals: 0.65-0.97); P = 0.026. Benefit was sustained in subgroup analyses, yet most appraised in low risk patients (<70-year-old; EuroSCORE <2; no diabetes) and when complete revascularization was achieved. Multiple as compared to single arterial grafting in atrial fibrillation patients undergoing CABG is safe and associated with improved mid-term survival. A particular survival benefit was observed in lower risk patients.Copyright {\textcopyright} 2020 Elsevier Inc. All rights reserved.",
keywords = "Multiple arterial grafting, CABG, Atrial fibrillation, Multivessel disease, Survival benefit, INTERNAL MAMMARY ARTERY, OXIDATIVE STRESS, LONG-TERM, SURVIVAL, OUTCOMES, METAANALYSIS, GUIDELINES",
author = "M. Kowalewski and M. Pasierski and R. Litwinowicz and M. Zembala and N. Piekus-Slomka and Z. Tobota and B. Maruszewski and P. Suwalski and {KROK Investigators}",
note = "Funding Information: KROK Investigators: Lech Anisimowicz MD, PhD (Bydgoszcz); Krzysztof Bartu{\'s} MD, PhD (Krak{\'o}w); Andrzej Biederman MD, PhD (Warszawa); Dariusz Borkowski MD (Radom); Miros{\l}aw Brykczy{\'n}ski MD, PhD (Szczecin); Pawe{\l} Bugajski MD, PhD (Pozna{\'n}); Pawe{\l} Cholewi{\'n}ski (Radom); Romuald Cicho{\'n} MD, PhD (Warszawa); Marek Cisowski MD, PhD (Bielsko-Bia{\l}a); Marek Deja MD, PhD (Katowice); Antoni Dziatkowiak MD, PhD (Krak{\'o}w); Tadeusz Gburek MD (Zamo{\'s}{\'c}); Witold Gerber MD (Bielsko-Bia{\l}a); Leszek Gryczko MD (Warszawa); Ireneusz Haponiuk MD (Gda{\'n}sk); Piotr Hendzel MD, PhD (Warszawa); Tomasz Hirnle MD, PhD (Bia{\l}ystok); Stanis{\l}aw Jab{\l}onka MD, PhD (Lublin); Krzysztof Jarmoszewicz MD (Gda{\'n}sk); Jaros{\l}aw Jasi{\'n}ski MD (Zielona G{\'o}ra); Marek Jasi{\'n}ski MD, PhD (Wroc{\l}aw); Ryszard Jaszewski MD, PhD ({\L}{\'o}d{\'z}); Marek Jemielity MD, PhD (Pozna{\'n}); Ryszard Kalawski MD, PhD (Pozna{\'n}); Bogus{\l}aw Kapelak MD, PhD (Krak{\'o}w); Maciej A. Karolczak MD, PhD (Warszawa); Jacek Kaperczak MD (Opole); Micha{\l} Krejca MD, PhD ({\L}{\'o}d{\'z}); Wojciech Kustrzycki MD, PhD (Wroc{\l}aw); Mariusz Ku{\'s}mierczyk MD, PhD (Warszawa); Pawe{\l} Kwinecki MD (Wroc{\l}aw); Leszek Markuszewski MD, PhD ({\L}{\'o}d{\'z}); Bohdan Maruszewski (Warszawa); Maurycy Missima MD (Bydgoszcz); Jacek J Moll MD, PhD ({\L}{\'o}d{\'z}); Wojciech Ogorzeja MD (Grudzi{\c a}dz); Jacek Paj{\c a}k MD (Katowice); Micha{\l} Pasierski (Warszawa); Wojciech Pawliszak MD (Bydgoszcz); Edward Pietrzyk MD (Kielce); Grzegorz Religa MD ({\L}{\'o}d{\'z}); Jan Rogowski MD, PhD (Gda{\'n}sk); Jacek R{\'o}{\.z}a{\'n}ski MD, PhD (Warszawa); Jerzy Sadowski MD, PhD (Krak{\'o}w); Girish Sharma MD (Wroc{\l}aw); Janusz Skalski MD, PhD (Krak{\'o}w); Jacek Skiba MD (Wroc{\l}aw); Ryszard Stanis{\l}awski MD (Nowa S{\'o}l); Janusz St{\c a}{\.z}ka MD, PhD (Lublin); Sebastian Stec MD, PhD (Warsaw); Piotr St{\c e}pi{\'n}ski MD (Nowa S{\'o}l); Grzegorz Suwalski MD (Warszawa); Kazimierz Suwalski MD, PhD (Warszawa); Piotr Suwalski MD, PhD (Warszawa); {\L}ukasz Tu{\l}ecki MD (Zamo{\'s}{\'c}); Kazimierz Widenka MD, PhD (Rzesz{\'o}w); Waldemar Wierzba MD (Warszawa); Micha{\l} Wojtalik MD, PhD (Pozna{\'n}); Stanis{\l}aw Wo{\'s} MD, PhD (Katowice); Marian Zembala MD, PhD (Zabrze); Micha{\l} Oskar Zembala MD, PhD (Zabrze) and Piotr {\.Z}elazny MD (Olsztyn). Funding: Current analysis did not receive any external funding. Publisher Copyright: {\textcopyright} 2020 Elsevier Inc.",
year = "2021",
doi = "10.1053/j.semtcvs.2020.11.015",
language = "English",
volume = "33",
pages = "974--983",
journal = "Seminars in Thoracic and Cardiovascular Surgery",
issn = "1043-0679",
publisher = "W.B. Saunders",
number = "4",
}