Objective: To identify the impact, if any, of single and multiple arterial grafting on the time-related incidence of new myocardial infarction after coronary artery grafting (CABG).

Methods: We followed 9600 consecutive patients from 1971-1997 who underwent first-time CABG using a variety of revascularization methods for occurrence of myocardial infarction (including perioperative) with 99.9% success. The possible benefit of extended arterial grafting was investigated in the hazard function domain using sequential multivariate analysis and adjusting for differences in prevalence of patients, procedures, and experience variables.

Results: The unadjusted one-month and one-, ten- and fifteen-year freedom from infarction rate was 97.3%, 96.7%, 86%, and 73%, respectively. After arterial grafting of any kind (n=6074), freedom from infarction was 88% and 77% at 10 and 15 years, compared to 82% and 72% with other conduit choices (n=3526; p<.0001). This modest benefit of arterial grafting persisted for perioperative infarcts (early phase, p=.03), in the intermediate term (constant hazard, p=.001), and late, particularly in comparison to non-arterial grafting to the left anterior descending coronary artery (LAD)(p=.0009). Additional benefits of extending arterial grafting (n=1202) beyond a single conduit could not be identified (p>.2). Survival after the follow-up infarct was improved (59% vs 48% at 10 years).

Conclusion: Arterial conduits should be utilized for CABG, particularly to a diseased LAD, to reduce the incidence of early and late new post-CABG myocardial infarction. However further reduction in incidence of infarction and its sequelae does not appear to be achieved by use of more than a single arterial graft.