Abstract 4369478: Comparative Outcomes of Multi-Arterial versus Single Arterial Grafting in Patients with Reduced Left Ventricular Ejection Fraction Undergoing Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis

Background: Patients with ischemic heart failure and reduced ejection fraction (HFrEF) remain at high risk despite surgical revascularization. While single arterial grafting (SAG) is standard in CABG, multi-arterial grafting (MAG) may offer better outcomes. However, its benefits in patients with reduced ejection fraction remain unclear. Aims: To evaluate whether MAG offers superior survival and clinical outcomes compared to SAG in patients with reduced LVEF undergoing CABG. Methods: A systematic search of PubMed, Embase, and Cochrane Central was conducted for studies comparing MAG and SAG in patients with LVEF <50%. Primary outcomes included 5-year overall survival, cardiac death, and in-hospital mortality. Secondary outcomes were MACE, perioperative MI, atrial fibrillation, reoperation, repeat revascularization, IABP use, stroke, and postoperative complications. Results: A total of 19,976 patients were included (MAG: 10,306; SAG: 9,670). MAG was associated with significantly higher 5-year survival (OR: 1.50; 95% CI: 1.32–1.70; p < 0.00001) and lower in-hospital mortality (OR: 0.66; 95% CI: 0.55–0.79; p < 0.00001), with a trend toward reduced cardiac death (OR: 0.75; 95% CI: 0.50–1.12; p = 0.16). No significant differences were seen in MACE (OR: 0.72; 95% CI: 0.49–1.04; p = 0.08), MI (OR: 0.72; 95% CI: 0.48–1.06; p = 0.09), or repeat revascularization (OR: 0.62; 95% CI: 0.23–1.68; p = 0.35). Reoperation was marginally lower with MAG (OR: 0.56; 95% CI: 0.31–1.00; p = 0.05). There were no significant differences in stroke (OR: 1.23; 95% CI: 0.92–1.65; p = 0.16), atrial fibrillation (OR: 0.93; 95% CI: 0.55–1.56; p = 0.78), IABP use (OR: 0.75; 95% CI: 0.49–1.15; p = 0.18), hospital stay (MD: 0.03; 95% CI: –0.64 to 0.70; p = 0.93), ICU stay (MD: 0.17; 95% CI: –0.30 to 0.63; p = 0.48), dialysis (OR: 0.92; 95% CI: 0.61–1.38; p = 0.68), or sternal wound infection (OR: 1.56; 95% CI: 0.83–2.94; p = 0.17). Conclusions: In patients with reduced LVEF undergoing CABG, MAG is associated with improved 5-year survival and lower in-hospital mortality without increased perioperative complications. These findings support broader consideration of MAG in this high-risk group.