Long-term Survival Equal in Two CABG Strategies

Largest US analysis shows patient age may guide optimal conduit selection

Jan. 31, 2026 at 6:47pm

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A late-breaking study drawing on more than 15 years of national outcomes data from the STS Adult Cardiac Surgery Database suggests that the two most commonly used multi-arterial coronary artery bypass grafting (CABG) strategies—bilateral internal thoracic artery (BITA) and single internal thoracic artery plus radial artery (SITA+RA)—offer comparable long-term survival overall, with important differences emerging by patient age.

Why it matters

The findings provide actionable insights for surgeons navigating conduit selection in multivessel coronary artery disease, particularly as multi-arterial grafting gains broader adoption. The study leverages the scale, granularity, and longitudinal linkage of the STS National Database to offer real-world evidence that can help inform future clinical guidelines, quality initiatives, and shared decision-making with patients.

The details

The study, led by Thomas Schwann, MD, of Corewell Health William Beaumont University Hospital, analyzed longitudinal outcomes from more than 2.1 million CABG patients in the STS Adult Cardiac Surgery Database from 2008 to 2023. Researchers identified over 172,000 patients who underwent multi-arterial bypass grafting with either BITA, SITA+RA, or both BITA and RA. Long-term survival was assessed through linkage with national death and claims databases. After rigorous propensity-score matching and risk adjustment, the study found equivalent 15-year survival between BITA and SITA+RA strategies overall, with improved survival for BITA in patients younger than 60 and lower mortality for SITA+RA in patients 70 and older. Additional survival benefit was seen when a third arterial conduit was used, regardless of strategy.

  • The study analyzed data from 2008 to 2023.
  • The findings were presented at the 2026 Society of Thoracic Surgeons Annual Meeting.

The players

Thomas Schwann, MD

Lead author of the study and a surgeon at Corewell Health William Beaumont University Hospital.

STS Adult Cardiac Surgery Database

A national database that provided the data for this large-scale analysis of multi-arterial CABG outcomes.

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What they’re saying

“These findings underscore the power of the STS National Database to answer clinically meaningful questions that randomized trials have struggled to resolve.”

— Thomas Schwann, MD, Lead author

“In a contemporary, real-world U.S. population, we found that both BITA and SITA plus radial artery strategies provide excellent long-term outcomes. Rather than a one-size-fits-all approach, our data suggest that patient age and life expectancy should play a central role in selecting the optimal multi-arterial bypass strategy.”

— Thomas Schwann, MD, Lead author

What’s next

The findings are expected to generate significant discussion at the 2026 STS Annual Meeting and may help inform future clinical guidelines, quality initiatives, and shared decision-making with patients.

The takeaway

This large-scale analysis of real-world data provides valuable insights to guide surgeons in selecting the optimal multi-arterial bypass grafting strategy for their patients, underscoring the importance of considering individual factors like age and life expectancy rather than a one-size-fits-all approach.