Multiple versus single arterial grafting in coronary artery bypass grafting: A meta-analysis of randomized controlled trials and propensity score studies

Objectives: We conducted a meta-analysis of randomized controlled trials (RCTs) and propensity score (PS) studies comparing survival and major adverse cardiac and cerebrovascular events (MACCEs) of patients who underwent coronary artery bypass grafting (CABG) with multiple (MAG) versus single arterial grafting (SAG). Methods: MEDLINE, Web of Science and Cochrane Library were used to find relevant literature (1960-2018). Survival at a follow-up ≥ 1 year, MACCEs and early outcomes were evaluated. Time-to-event outcomes were collected through hazard ratio (HR) along with their variance, and the other endpoints using frequencies from matched sample or adjusted 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). Results: Twenty-nine PS cohorts and 8 RCTs comprising 122832 patients (52178 MAG and 70654 SAG) were included in this meta-analysis. MAG was associated with lower early mortality (OR: 0.82, 95%CI: 0.71-0.95, p=0.007), long-term mortality (HR: 0.76, 95%CI: 0.73-0.78, p<0.001) and MACCEs (HR: 0.85, 95%CI: 0.79-0.91, p<0.001). Increased risk of sternal wound complications (SWC) was only observed when the bilateral internal mammary artery configuration was used for MAG (OR MAG BIMA:1.96, 95%CI: 1.37-2.81, p<0.001). Conclusion: Although the BIMA configuration increases the risk of SWC, MAG improves both early and long-term survival as well as MACCEs in CABG.