Meta-Analysis Comparing Multiple Arterial Grafts Versus Single Arterial Graft for Coronary-Artery Bypass Grafting.

Observational studies and randomized controlled trials (RCTs) have shown conflicting outcomes for multiple arterial graft (MAG) coronary artery bypass graft surgery compared with single arterial grafts (SAGs). The predominant evidence supporting the use of MAGs is observational. The aim of this meta-analysis of RCTs is to compare outcomes following MAG and SAG. We searched multiple databases for RCTs comparing MAG versus SAG. The clinical outcomes studied were all-cause mortality, cardiac mortality, myocardial infarction (MI), revascularization, stroke, sternal wound complications, and major bleeding. We used hazard ratio (HR), relative risk (RR), and corresponding 95% confidence interval (CI) for measuring outcomes. Ten RCTs (6392 patients) were included. The average follow-up in the studies was 4.2 years. The average age of the patients in the studies ranged from 56.3 years to 74.6. No significant difference was seen between MAG and SAG groups for all-cause mortality (11.8% vs 12.7%, HR 0.94, 95% CI 0.81 to 1.09, p 0.36), cardiac mortality (4.1% vs 4.5%, HR 0.96 95% CI 0.74 to 1.26, p 0.77), MI (3.5% vs 5.1%, HR 0.87 95% CI 0.67 to 1.12, p 0.28), and major bleeding (3.3% vs 4.9%, RR 0.85 95% CI 0.64 to 1.13, p 0.26). Repeat revascularization in MAG showed a lower RR than SAG when one of the confounding studies was excluded (RR 0.63, 95% CI 0.4 to 0.99, p 0.04). The incidence of stroke was lower in MAG than SAG (2.9% vs 3.9%, RR 0.74 95% CI 0.56 to 0.98, p 0.03). MAG had higher incidence of sternal wound complications than SAG (2.9% vs 1.7%, RR 1.75 95% CI 1.19 to 2.55, p 0.004). In conclusion, MAG does not have a survival advantage compared with SAG but is better in revascularization and risk of stroke. This benefit may be set off by a higher incidence of sternal wound complications in MAG.

Paradoxical increase in stroke mortality among Asian Indians in the United States.

OBJECTIVE: To better characterize the stroke mortality and risk factors among Asian Indians by using U.S. multiple-cause-of-death and National Health and Interview Survey data. METHODS: Age-adjusted fatal stroke incidence, stroke rate ratio with 95% confidence interval, and average annual percentage change (APC) over 10 years were calculated. RESULTS: The annual incidence of stroke mortality in 2000 was lowest among Asian Indians (88 per 100,000) followed by American Indians and Alaska Natives (112 per 100,000), whites (301 per 100,000) and African Americans (312 per 100,000). Significantly lower rates of hypertension and cigarette smoking in Asian Indians in 2000-2001 (compared with whites) explained the lower rates of stroke mortality. The APC increase over subsequent 10 years was 13.5%, 0.9%, -2.5%, and -2.9% for Asian Indians, American Indians and Alaska Natives, whites, and African Americans, respectively. CONCLUSIONS: There is a paradoxical increase in stroke mortality among Asian Indians over the last 10 years in contrast to other population subsets.