title: Multiple arterial bypass grafting should be routine.
abstract: OBJECTIVE
  We sought to estimate the reduction in deaths and the number of additional person-years of life that could potentially be gained by nationwide adoption of routine multiple arterial bypass grafting (MABG).
  
  
  METHODS
  Propensity matching on 4883 patients undergoing primary, isolated coronary artery bypass grafting (CABG) using the left internal thoracic artery (LITA) from January 1995 to June 2011, resulted in 1023 matched pairs of LITA-radial artery and LITA-saphenous vein patients. Kaplan-Meier estimated survivals were used to calculate the potential number of lives that could be saved based on a 20% and an 80% rate of MABG, compared with the national 10% rate, when applied to a hypothetical national sample of 200,000 similar patients.
  
  
  RESULTS
  Our overall MABG rate was 40% with >80% rate for the past 3 years. Kaplan-Meier estimated 10-year survival was better for LITA-radial artery patients (83.1%) compared with LITA-saphenous vein patients (75.7%) (log rank test, P < .001). When compared with the current national 10% MABG rate, a 20% and an 80% MABG rate could potentially result in 1400 and 10,000 fewer annual deaths, respectively, among a hypothetical national cohort, yielding >9000 and >64,000 person-years of life over a 10-year period.
  
  
  CONCLUSIONS
  An 80% rate of MABG has the potential to prevent more than 10,000 deaths annually and add >64,000 person-years of life over the course of 10 years. The use of a second arterial graft during CABG should be routine in the majority of patients undergoing CABG.
authors.affiliation: Department of Cardiovascular Surgery, Mount Sinai Beth Israel, New York, NY. Electronic address: rft9008@med.cornell.edu.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Tranbaugh
authors.affiliation: Division of Grants and Research Administration, Mount Sinai Beth Israel, New York, NY.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lucido
authors.affiliation: Department of Cardiovascular Surgery, Mount Sinai Beth Israel, New York, NY.
authors.forename: Kamellia R
authors.initials: KR
authors.lastname: Dimitrova
authors.affiliation: Division of Cardiothoracic Surgery, Arnot Ogden Medical Center, Elmira, NY.
authors.forename: Darryl M
authors.initials: DM
authors.lastname: Hoffman
authors.affiliation: Division of Cardiac Surgery, Crozer Chester Medical Center, Upland, Pa.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Geller
authors.affiliation: Department of Cardiovascular Surgery, Mount Sinai Beth Israel, New York, NY.
authors.forename: Gabriela R
authors.initials: GR
authors.lastname: Dincheva
authors.affiliation: Department of Cardiovascular Surgery, Mount Sinai Beth Israel, New York, NY.
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D017534:Radial Artery / Q000637:transplantation*; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D015996:Survival Rate
keywords: CABG; radial artery grafting