Bilateral vs Single Arterial Grafting in CABG: No Survival Advantage at 15 Years, suggests JAMA Study
Researchers have found in a new study that a 15-year follow-up found no significant difference in all-cause mortality between patients undergoing coronary artery bypass graft surgery (CABG) with bilateral versus single internal thoracic artery grafts. However, treatment crossovers and the use of additional radial artery grafts may have influenced outcomes, warranting further randomized trials to clarify the benefits of multiple arterial grafting. The study was published in JAMA Cardiology by David P. and colleagues.
The current secondary analysis provides the extended results of an unblinded, international randomized clinical trial that was initially carried out in 28 cardiac surgery centers in 7 countries from June 2004 through December 2007. The inclusion criterion was the patients' eligibility to receive clinically indicated CABG, while exclusion criteria included the need for only single vessel grafting, simultaneous valve operation and the patients' history of previous CABG surgery.
The data of all 3102 patients that were initially recruited for this trial and participated in the study for its entire 15-year period have been included into the extended analysis. The 15-year analysis data were analyzed in January–March 2026. In both groups of patients, auxiliary conduits such as saphenous vein or radial artery grafts were employed based on clinical need by the surgical team. The main endpoint assessed was mortality due to any cause after 15 years, whereas the secondary combined endpoint was death for any cause, myocardial infarction, or stroke.
Key findings:
- The intention-to-treat study population comprised 1548 patients randomized to the bilateral graft group and 1554 patients assigned to the single graft group.
- Overall, participants had a mean (SD) age of 64 (9) years, and 446 (15%) were female. Complete vital status was established for 3039 patients (98%) at the 15-year milestone.
- Recorded in 585 patients (37.8%) in the bilateral graft cohort compared to 584 patients (37.6%) in the single graft cohort (hazard ratio [HR], 1.00; 95% CI, 0.89-1.12; P = 0.97).
- Events occurred in 43.9% of the bilateral graft group versus 45.8% of the single graft group (HR, 0.94; 95% CI, 0.85-1.05).
- In the bilateral graft arm, 215 patients (14%) ultimately received only a single arterial graft, whereas in the single graft arm, 359 patients (23%) additionally received a radial artery graft.
This extended follow-up of 15 years does not find any survival advantage of bilateral versus single internal thoracic artery grafts in clinical practice of routine CABG.
Reference:
Taggart DP, Gaudino M, Gerry S, et al. Long-Term Outcomes Following Bilateral vs Single Internal Thoracic Artery Grafts: A Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiol. Published online September 02, 2026. doi:10.1001/jamacardio.2026.3232
