A late-breaking study drawing on more than 15 years of national outcomes data from the STS Adult Cardiac Surgery Database (ACSD) suggests that the two most commonly used multi-arterial coronary artery bypass grafting (CABG) strategies-bilateral internal thoracic artery (BITA) and single internal thoracic artery plus radial artery (SITA+RA)-offer comparable long-term survival overall, with important differences emerging by patient age.<\/p>\n
The findings were presented as a late-breaking abstract at the 2026 Society of Thoracic Surgeons Annual Meeting, the world’s premier forum for cardiothoracic surgery research and innovation.<\/p>\n
The study, led by Thomas Schwann, MD, of Corewell Health William Beaumont University Hospital, represents the largest comparative effectiveness analysis to date of multi-arterial bypass grafting platforms in US practice, leveraging the depth, longitudinal follow-up, and real-world applicability of the ACSD.<\/p>\n
Using ACSD data from 2008 to 2023, investigators analyzed longitudinal outcomes from more than 2.1 million CABG patients, ultimately identifying over 172,000 patients who underwent multi-arterial bypass grafting with either BITA, SITA+RA, or both BITA and RA. Long-term survival-extending up to 15 years-was assessed through linkage with the Centers for Disease Control and Prevention’s National Death Index and Centers for Medicare & Medicaid Services claims databases, providing a level of follow-up rarely achievable in surgical studies.<\/p>\n
After rigorous propensity-score matching and robust risk adjustment, the study found:<\/p>\n
\n\tEquivalent 15-year survival between BITA and SITA+RA strategies overall
\n\tImproved survival with BITA in patients younger than 60 years
\n\tLower mortality with SITA+RA in patients aged 70 years and older
\n\tEarly (0\u20135 year) survival advantage for SITA+RA, with BITA trending toward benefit beyond 10 years
\n\tAdditional survival benefit when a third arterial conduit was used, regardless of strategy
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Importantly, the study also documents a steady increase in multi-arterial CABG use across the US, rising from approximately 9% to more than 16% over the past decade, driven largely by growth in SITA+RA use.<\/p>\n
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These findings underscore the power of the STS National Database to answer clinically meaningful questions that randomized trials have struggled to resolve.”<\/p>\n
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Dr. Thomas Schwann, lead author of the study<\/p>\n
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“In a contemporary, real-world U.S. population, we found that both BITA and SITA plus radial artery strategies provide excellent long-term outcomes,” Dr. Schwann said. “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.<\/p>\n
Given the improved survival associated with additional arterial grafts beyond two, this should encourage and challenge surgeons to use as many arterial grafts as possible to optimize outcomes.”<\/p>\n
By leveraging the scale, granularity, and longitudinal linkage of the STS National Database, the study provides actionable insights for surgeons navigating conduit selection in multivessel coronary artery disease, particularly as multi-arterial grafting gains broader adoption.<\/p>\n
The findings are expected to generate significant discussion at the 2026 STS Annual Meeting and may help inform future clinical guidelines, quality initiatives, and shared decision-making with patients.<\/p>\n
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