A study shows that both young and old patients experience long-term survival benefits after undergoing total arterial revascularization (TAR) for coronary artery disease (CAD). These data were reported by Justin Ren, PhD, from the University of Melbourne, Australia, and colleagues from Australia, US, United Arab Emirates and Malaysia, in a manuscript published online Wednesday in JACC: Advances. Most elderly patients with CAD undergoing coronary artery bypass grafting (CABG) do not undergo total arterial CABG due to perceived surgical risks and lower life expectancies. Few studies have investigated the use of TAR in very elderly patients for this reason. The investigators in the present study examined the survival benefits of TAR versus conventional non-TAR grafting in patients who were elderly (≥70 years old) or non-elderly (<70 years old). A binational cardiac surgery registry was used to collect data between 2001 and 2020 from patients who underwent primary isolated CABG with at least 2 grafts. Within the 2 age groups, survival outcomes were compared between patients who had TAR and those who had non-TAR plus at least one saphenous vein graft. The primary endpoint of this study was long-term all-cause mortality. A total of 59,641 patients were included in the analysis. Patients who underwent TAR had significantly higher survival rates than patients who did not in both the elderly (hazard ratio [HR]=0.87, 95% confidence interval [CI]=0.81-0.92, p<0.001) and younger (HR=0.80, 95% CI=0.73-0.88, p<0.001) patients. Patients who underwent TAR had the highest survival rates, followed by patients who had non-TAR multiple arterial grafting. The group with the lowest survival rates consisted of patients who received non-TAR single arterial grafting. The authors of the study noted several limitations, including the standard limitations of retrospective, observational design; institutional and surgeon differences; and the lack of data on postoperative complications other than death, such as graft failure, myocardial infarction or repeat revascularization. Overall, TAR improved survival rates in both elderly and non-elderly patients who underwent CABG. Source: Ren J, Reid CM, Smith JA, et al. Long-term survival advantage of total arterial revascularization in elderly patients following coronary artery bypass grafting. JACC Advances. 2025 October 8 (Article in press). Image Credit: MQ-Illustrations – stock.adobe.com