Age Influences Optimal CABG Strategy: BITA vs. SITA+RA, Large Study Finds
A comprehensive study, drawing on over 15 years of national outcomes data from the STS Adult Cardiac Surgery Database (ACSD), suggests that patient age significantly influences the optimal selection between two common multi-arterial coronary artery bypass grafting (CABG) strategies: bilateral internal thoracic artery (BITA) and single internal thoracic artery plus radial artery (SITA+RA). Presented at the 2026 Society of Thoracic Surgeons Annual Meeting, this research represents the largest comparative effectiveness analysis of multi-arterial bypass grafting in US practice.
The study analyzed longitudinal outcomes from more than 2.1 million CABG patients from 2008 to 2023, identifying over 172,000 who underwent multi-arterial bypass grafting. Long-term survival, extending up to 15 years, was assessed through linkage with national death and claims databases.
Key Findings on Survival Outcomes
- Overall 15-year survival between BITA and SITA+RA strategies was equivalent.
- BITA showed improved survival in patients younger than 60 years.
- SITA+RA demonstrated lower mortality in patients aged 70 years and older.
- An early (0–5 year) survival advantage was observed for SITA+RA, while BITA trended toward benefit beyond 10 years.
- Additional survival benefit was found when a third arterial conduit was used, regardless of the primary strategy.
Rising Utilization of Multi-Arterial CABG
The study also documented an increase in multi-arterial CABG use in the US, rising from approximately 9% to over 16% in the last decade, primarily due to growth in SITA+RA utilization.
Expert Insight
Dr. Thomas Schwann, lead author, stated that the findings indicate both BITA and SITA+RA strategies provide long-term outcomes in a real-world US population. The data suggests that patient age and life expectancy should be considered in selecting the optimal multi-arterial bypass strategy. The improved survival associated with additional arterial grafts encourages surgeons to use as many as possible to optimize outcomes.
Informing Future Practice
These insights are expected to inform future clinical guidelines and shared decision-making in multivessel coronary artery disease.