Comparable long-term survival seen in two common CABG strategies
A late-breaking study at the 2026 Society of Thoracic Surgeons (STS) annual meeting showed the two most commonly used multi-artery coronary artery bypass grafting (CABG) strategies offer similar long-term survival, but age may play a role in which to choose.
Bilateral internal thoracic artery (BITA) and single internal thoracic artery plus radial artery (SITA+RA) CABG procedures have seen a large amount of growth in the past two decades and there have been clinical questions on which approach is best for patients. This analysis of more than 15 years of national outcomes data from the STS Adult Cardiac Surgery Database (ACSD) shows a steady increase in multi-arterial CABG in the U.S. It rose from about 9% to more than 16% in the past decade, with the largest growth seen in SITA+RA.
The study showed overall equivalent 15-year survival rates between the strategies, but the ages of the patients played a role in their outcomes. BITA had better survival in patients younger than 60 years, and SITA+RA had lower mortality in patients age 70 and older.
“In a contemporary, real-world U.S. population, we found that both BITA and SITA plus radial artery strategies provide excellent long-term outcomes. Rather than a one-size-fits-all approach, our data suggest that patient age and life expectancy should play a central role in selecting the optimal multi-arterial bypass strategy," explained lead author and presenter Thomas Schwann, MD, MBA, chief of cardiovascular surgery, Corewell Health William Beaumont University Hospital, in a statement from STS.
The data also show an early survival advantage for SITA+RA in the first five years. But BITA showed survival benefit beyond 10 years. The researchers also found there was an additional survival benefit when a third arterial conduit was used, regardless of CABG strategy used.
He said the study represents the largest comparative effectiveness analysis to date of multi-arterial bypass grafting platforms in U.S. practice, leveraging the depth, longitudinal follow-up, and real-world applicability of the ACSD. Researchers used ACSD data from more than 2.1 million CABG patients between 2008-2023 to 172,000 patients who underwent multi-arterial bypass grafting with either BITA, SITA+RA, or both BITA and RA. Long-term survival was assessed through cross analysis with the Centers for Disease Control and Prevention’s National Death Index and Centers for Medicare and Medicaid Services (CMS) claims databases. Schwann said this cross analysis with government data offers rare long-term followup data on CABG durability and mortality.
“These findings underscore the power of the STS National Database to answer clinically meaningful questions that randomized trials have struggled to resolve,” Schwann added.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]