Multivessel Versus Single-Vessel Coronary Endarterectomy as an Adjunct to Coronary Artery Bypass Grafting: A Meta-Analysis of Short-Term Outcomes and Implications for Target-Vessel Selection.
Joshua J Hon, Arian Arjomandi Rad, Abdullah Tahir et al.
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In 30 seconds
This meta-analysis compared short-term outcomes after single-vessel versus multivessel coronary endarterectomy (CE) performed with coronary artery bypass grafting (CABG), using studies that reported both groups within the same cohort. Nine studies published from 1988 to 2022 included 7,302 patients. Multivessel CE was associated with higher 30-day or in-hospital mortality than single-vessel CE (RR, 2.59; 95% CI, 1.78-3.77), as well as higher perioperative myocardial infarction and stroke. The authors note that the evidence is largely retrospective and unadjusted.
Key findings
- Multivessel CE was associated with higher mortality than single-vessel CE (RR, 2.59; 95% CI, 1.78-3.77).
- Perioperative myocardial infarction was higher with multivessel CE (RR, 2.09; 95% CI, 1.67-2.62).
- Stroke was higher with multivessel CE (RR, 1.62; 95% CI, 1.01-2.61); intra-aortic balloon pump use did not differ.
Why it matters
CE can extend revascularization for diffuse coronary disease unsuitable for conventional bypass, but these pooled findings associate treatment of multiple vessels with greater early mortality, infarction, and stroke. The results highlight a potential trade-off between achieving more complete revascularization and perioperative risk, while the retrospective, largely unadjusted evidence limits causal interpretation.
What to keep in mind
The evidence was largely retrospective and unadjusted, and the comparisons were based on study-level cohorts rather than randomized allocation.