New publication in the Journal of the American College of Cardiology
At a glance
A large national analysis of over 1.2 million Medicare beneficiaries tackling a long-standing question in cardiac surgery: whether multiarterial grafting during coronary artery bypass grafting truly improves survival.
This large national analysis of over 1.2 million Medicare beneficiaries examined whether multiarterial grafting during coronary artery bypass grafting improves survival compared to single arterial grafting. The researchers employed flexible parametric survival models with time-dependent effects and regression standardisation to calculate standardised survival probabilities, evaluating two analytical strategies: a conventional risk-adjusted model and an instrumental variable model using surgeon multiarterial-grafting rate as the instrument.
The conventional model indicated a modest survival advantage for multiarterial grafting, aligning with previous observational research. The instrumental variable model, however, did not demonstrate this association, suggesting the observed survival benefit may result from unmeasured confounding related to patient selection and surgeon decision-making rather than the procedure itself.