Survival Outcomes After Multiple vs Single Arterial Grafting Among Patients With Reduced Ejection Fraction

This retrospective cohort study evaluated the impact of preoperative ischemic heart failure with reduced ejection fraction on long-term outcomes following coronary revascularization using either single or multiple arterial grafting techniques. Data from 59,641 patients (mean age 65.8 years; 81 percent male) across 59 cardiac centers (2001–2020) were analyzed, with patients stratified by perioperative left ventricular ejection fraction (EF). Over a median follow-up of five years, multiarterial grafting was associated with a 19 percent reduction in all-cause mortality for those with normal EF (hazard ratio [HR]=0.81, P<0.001), and similar benefits were observed in patients with mild (HR=0.83), moderate (HR=0.82), and severe left ventricular (LV) impairment (HR=0.82, P=0.01). Cox regression analysis showed no significant interaction between survival benefit and EF (P=0.75). Total arterial revascularization provided additional survival benefits except in cases with EF less than 30 percent (HR=0.87, P=0.30). These findings support the consistent survival advantage of multiarterial grafting across LV function levels and advocate for the broader use of these strategies.