Multiple versus single arterial grafting in the elderly: a meta-analysis of randomized controlled trials and propensity score studies

Autores da FMUP

• Francisca Almeida Saraiva

  Autor

• Rui João Gonçalves Cerqueira

  Autor

• Jennifer Mâncio Silva

  Autor

• António Sousa Barros

  Autor

• André Pedro Leite Martins Lourenço

  Autor

• Joaquim Adelino Correia Ferreira Leite Moreira

  Autor

Participantes de fora da FMUP

• Moreira, R

Unidades de investigação

• Cirurgia e Fisiologia

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

INTRODUCTION: The benefit of adding a second arterial conduit is still controversial, mainly in specific subgroups. We conducted a meta-analysis of randomized controlled trials (RCTs) and propensity score (PS) studies comparing survival and early results in elderly patients who underwent coronary' artery bypass grafting (CABG) with multiple (MAG) versus single arterial grafting (SAG). EVIDENCE ACQUISITION: MEDLINE, Web of Science and Cochrane Library were used to find relevant literature (1960-April 2020). Survival at a >= 1-year follow-up and early outcomes were evaluated. Outcomes were collected from matched samples or PS adjusted analysis: hazard ratio (HR) along with their variance, frequencies or odds ratios. Random effect models were used to compute combined statistical measures and 95% confidence intervals (CI) through generic inverse variance method (time-to-event) or Mantel-Haenszel method (binary events). EVIDENCE SYNTHESIS: Eleven PS cohorts and 1 RCT comprising >18,800 patients older than 70 (>6200 MAG and >12,500 SAG) were included in this meta-analysis. MAG was associated with lower long-term mortality (pooled HR: 0.81, 95% CI: 0.72-0.91, P<0.01, I-2 =64%) in the absence of higher risk of early mortality (pooled OR: 0.74, 95% CI: 044 to 1.25, P=0.27, I-2 =0%). In a meta-regression. MAG survival advantage was more pronounced in studies with a higher MAG usage rate (beta=-0.0052, P=0.021). CONCLUSIONS: Current evidence suggests that advanced age should not limit MAG's use considering its benefits in lona-term survival. Of note, an individualized patient selection for this approach is warranted.

Keywords

• Coronary artery bypass; Aged; Internal mammary-coronary artery anastomosis; Survival