Copyright © 1993 by the European Society of Cardiology.
© 1993 The Europen Society of Cardiology
Multiarterial coronary artery bypass grafting with special reference to small vessel disease and results in women
*Department of Cardio-thoracic Surgery, University Hospital Uppsala, Sweden
Department of Thoracic Radiology, University Hospital Uppsala, Sweden
Received 13 August 1992; revised 6 November 1992; .
Correspondence: Johan Ramström, MD, Department of Cardio-thoracic Surgery, University Hospital, 751 85 Uppsala, Sweden
Abstract
From 1985 to 1991 a total of 220 patients underwent coronary artery bypass grafting (CABG) with at least two native pedicled artery grafts. Bilateral internal mammary artery (IMA) grafting was performedin 201 patients, IMA combined with gastro-epiploic artery (GEA) grafting in five, and double IMA plus GEA grafting in 14; in addition 156 patients received 1–3 vein grafts. The primary indication for elective multi-arterial CABG was coronary arteries of small calibre (small vessel disease) in 77 patients, repeat CABG in 17 (without small vessel disease), varicose/stripped saphenous veins in 57 (without small vessel disease), while the remaining 69 were routine cases; the distribution differed between women (42, 0, 47, and 11%, respectively) and men (33, 10, 19, and 38%, respectively; P<0.0001). The women also were older (62±7 vs 56±9 years; P<0.0001), and had higher prevalences of systemic hypertension, diabetes mellitus, and hypercholesterolaemia. The number of artery grafts and total number of grafts were, however, similar for women and men. Early mortality (
30 days) was 5.6% in women and 2.4% in men (ns). Early mortalities in relation to primary indications were: 7.8% for small vessel disease, 5.9% for repeat CABG, and 0% for both varicose/stripped saphenous veins androutine cases (P<0.05). Logistic regression analysis identified small vessel disease, insufficient grafting, age of 
60 years, a history of smoking, a family history of ischaemic heart disease, and female gender as independent risk factors for early mortality. Stratified analysis of early mortality for gender against each of the other risk factors showed that the influence of female gender was explained by a significantly more pronounced impact of small vessel disease in women than in men. Intraoperative flow measurements in the IMA grafts showed no difference between men and women, and postoperative angiographic artery graft patency was 92% in men and 94% in women. An aggressive approach with multiple artery grafting thus seems justified in any situation with exhausted venous reserves. Small vessel disease represents a special indication for primary multiple arterial grafting; the higher prevalence and more severe impact of small vessel disease makes optimal graft quality and surgical anastomosis technique especially important in women.
Key Words: Coronary artery disease • coronary artery bypass grafting • multiple artery grafting • small vessel disease
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