title: Three Arterial Grafts Improve Late Survival: A Meta-Analysis of Propensity-Matched Studies.
abstract: BACKGROUND
  Little evidence shows whether a third arterial graft provides superior outcomes compared with the use of 2 arterial grafts in patients undergoing coronary artery bypass grafting. A meta-analysis of all the propensity score-matched observational studies comparing the long-term outcomes of coronary artery bypass grafting with the use of 2-arterial versus 3-arterial grafts was performed.
  
  
  METHODS
  A literature search was conducted using MEDLINE, EMBASE, and Web of Science to identify relevant articles. Long-term mortality in the propensity score-matched populations was the primary end point. Secondary end points were in-hospital/30-day mortality for the propensity score-matched populations and long-term mortality for the unmatched populations. In the matched population, time-to-event outcome for long-term mortality was extracted as hazard ratios, along with their variance. Statistical pooling of survival (time-to-event) was performed according to a random effect model, computing risk estimates with 95% confidence intervals.
  
  
  RESULTS
  Eight propensity score-matched studies reporting on 10 287 matched patients (2-arterial graft: 5346; 3-arterial graft: 4941) were selected for final comparison. The mean follow-up time ranged from 37.2 to 196.8 months. The use of 3 arterial grafts was not statistically associated with early mortality (hazard ratio, 0.93; 95% confidence interval, 0.71-1.22;P=0.62). The use of 3 arterial grafts was associated with statistically significantly lower hazard for late death (hazard ratio, 0.8; 95% confidence interval, 0.75-0.87;P<0.001), irrespective of sex and diabetic mellitus status. This result was qualitatively similar in the unmatched population (hazard ratio, 0.57; 95% confidence interval, 0.33-0.98;P=0.04).
  
  
  CONCLUSIONS
  The use of a third arterial conduit in patients with coronary artery bypass grafting is not associated with higher operative risk and is associated with superior long-term survival, irrespective of sex and diabetic mellitus status.
authors.affiliation: From Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., A.D.F., L.B.O., L.N.G.); Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.D.P.); Città della Scienza e della Salute, Department of Cardiology, University of Turin, Italy (M.I., U.B., F.D., F.G.); Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (D.G., J.B.G.); Bristol Heart Institute, University of Bristol, UK (U.B.); and Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, UK (D.P.T.). mfg9004@med.cornell.edu.
authors.forename: Mario
authors.initials: M
authors.lastname: Gaudino
authors.affiliation: From Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., A.D.F., L.B.O., L.N.G.); Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.D.P.); Città della Scienza e della Salute, Department of Cardiology, University of Turin, Italy (M.I., U.B., F.D., F.G.); Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (D.G., J.B.G.); Bristol Heart Institute, University of Bristol, UK (U.B.); and Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, UK (D.P.T.).
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
authors.affiliation: From Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., A.D.F., L.B.O., L.N.G.); Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.D.P.); Città della Scienza e della Salute, Department of Cardiology, University of Turin, Italy (M.I., U.B., F.D., F.G.); Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (D.G., J.B.G.); Bristol Heart Institute, University of Bristol, UK (U.B.); and Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, UK (D.P.T.).
authors.forename: Antonino
authors.initials: A
authors.lastname: Di Franco
authors.affiliation: From Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., A.D.F., L.B.O., L.N.G.); Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.D.P.); Città della Scienza e della Salute, Department of Cardiology, University of Turin, Italy (M.I., U.B., F.D., F.G.); Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (D.G., J.B.G.); Bristol Heart Institute, University of Bristol, UK (U.B.); and Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, UK (D.P.T.).
authors.forename: Lucas B
authors.initials: LB
authors.lastname: Ohmes
authors.affiliation: From Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., A.D.F., L.B.O., L.N.G.); Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.D.P.); Città della Scienza e della Salute, Department of Cardiology, University of Turin, Italy (M.I., U.B., F.D., F.G.); Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (D.G., J.B.G.); Bristol Heart Institute, University of Bristol, UK (U.B.); and Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, UK (D.P.T.).
authors.forename: Mario
authors.initials: M
authors.lastname: Iannaccone
authors.affiliation: From Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., A.D.F., L.B.O., L.N.G.); Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.D.P.); Città della Scienza e della Salute, Department of Cardiology, University of Turin, Italy (M.I., U.B., F.D., F.G.); Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (D.G., J.B.G.); Bristol Heart Institute, University of Bristol, UK (U.B.); and Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, UK (D.P.T.).
authors.forename: Umberto
authors.initials: U
authors.lastname: Barbero
authors.affiliation: From Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., A.D.F., L.B.O., L.N.G.); Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.D.P.); Città della Scienza e della Salute, Department of Cardiology, University of Turin, Italy (M.I., U.B., F.D., F.G.); Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (D.G., J.B.G.); Bristol Heart Institute, University of Bristol, UK (U.B.); and Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, UK (D.P.T.).
authors.forename: David
authors.initials: D
authors.lastname: Glineur
authors.affiliation: From Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., A.D.F., L.B.O., L.N.G.); Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.D.P.); Città della Scienza e della Salute, Department of Cardiology, University of Turin, Italy (M.I., U.B., F.D., F.G.); Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (D.G., J.B.G.); Bristol Heart Institute, University of Bristol, UK (U.B.); and Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, UK (D.P.T.).
authors.forename: Juan B
authors.initials: JB
authors.lastname: Grau
authors.affiliation: From Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., A.D.F., L.B.O., L.N.G.); Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.D.P.); Città della Scienza e della Salute, Department of Cardiology, University of Turin, Italy (M.I., U.B., F.D., F.G.); Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (D.G., J.B.G.); Bristol Heart Institute, University of Bristol, UK (U.B.); and Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, UK (D.P.T.).
authors.forename: Umberto
authors.initials: U
authors.lastname: Benedetto
authors.affiliation: From Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., A.D.F., L.B.O., L.N.G.); Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.D.P.); Città della Scienza e della Salute, Department of Cardiology, University of Turin, Italy (M.I., U.B., F.D., F.G.); Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (D.G., J.B.G.); Bristol Heart Institute, University of Bristol, UK (U.B.); and Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, UK (D.P.T.).
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: From Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., A.D.F., L.B.O., L.N.G.); Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.D.P.); Città della Scienza e della Salute, Department of Cardiology, University of Turin, Italy (M.I., U.B., F.D., F.G.); Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (D.G., J.B.G.); Bristol Heart Institute, University of Bristol, UK (U.B.); and Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, UK (D.P.T.).
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
authors.affiliation: From Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., A.D.F., L.B.O., L.N.G.); Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.D.P.); Città della Scienza e della Salute, Department of Cardiology, University of Turin, Italy (M.I., U.B., F.D., F.G.); Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (D.G., J.B.G.); Bristol Heart Institute, University of Bristol, UK (U.B.); and Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, UK (D.P.T.).
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Girardi
authors.affiliation: From Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., A.D.F., L.B.O., L.N.G.); Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.D.P.); Città della Scienza e della Salute, Department of Cardiology, University of Turin, Italy (M.I., U.B., F.D., F.G.); Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (D.G., J.B.G.); Bristol Heart Institute, University of Bristol, UK (U.B.); and Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, UK (D.P.T.).
authors.forename: David P
authors.initials: DP
authors.lastname: Taggart
mesh_terms: D001807:Blood Vessel Prosthesis; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D006801:Humans; D057216:Propensity Score; D016016:Proportional Hazards Models; D012737:Sex Factors; D015996:Survival Rate
keywords: bilateral internal thoracic arteries; radial artery; total arterial revascularization