A late study based on more than 15 years of national outcome data from the STS Adult Cardiac Surgery Database (ACSD) suggests that the two most commonly used multiartery coronary artery bypass graft (CABG) strategies—bilateral internal thoracic artery (BITA) and single internal thoracic artery (BITA) and single thoracic artery—long-term overall survival, with significant differences that arise depending on the age of the patient.
The findings were presented as a late abstract at the 2026 Society of Thoracic Surgeons Annual Meeting, the world’s leading forum for research and innovation in cardiothoracic surgery.
The study, led by Thomas Schwann, MD, of Corewell Health William Beaumont University Hospital, represents the largest comparative effectiveness analysis to date of multiarterial bypass graft platforms in US practice, leveraging the depth, longitudinal follow-up, and real-world application of ACSD.
Using ACSD data from 2008 to 2023, researchers analyzed longitudinal outcomes from more than 2.1 million CABG patients, ultimately identifying more than 172,000 patients who underwent multiarterial bypass grafting with either BITA, SITA+RA, or BITA and RA. Long-term survival—spanning up to 15 years—was assessed through linkage to 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 achieved in surgical studies.
After strict propensity score matching and robust risk adjustment, the study found:
- Equivalent 15-year survival between BITA and SITA+RA strategies overall
- Improved survival with BITA in patients under 60 years of age
- Lower mortality with SITA+RA in patients aged 70 years and older
- Early survival advantage (0–5 years) for SITA+RA, with BITA tending to benefit beyond 10 years
- Additional survival benefit when a third arterial conduit was used, regardless of strategy
Importantly, the study also documents a steady increase in the use of multiarterial CABG in the US, rising from approximately 9% to more than 16% over the past decade, due to the increase in SITA+RA use.
These findings highlight the power of the National STS Database to answer clinically important questions that randomized trials have struggled to address.”
Dr. Thomas Schwann, lead author of the study
“In a contemporary, real-world US population, we found that both BITA and SITA plus radial artery strategies provide excellent long-term results,” said Dr. Schwann. “Rather than a one-size-fits-all approach, our data suggest that patient age and life expectancy should play a central role in choosing the optimal multiarterial bypass strategy.
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.”
Leveraging the scale, granularity, and longitudinal linkage of the National STS Database, the study provides useful information for surgeons navigating conduit selection in multivessel coronary disease, particularly as multivessel grafting gains wider adoption.
The findings are expected to generate important discussion at the 2026 STS Annual Meeting and may help inform future clinical guidelines, quality initiatives and shared decision-making with patients.
Source:
