ADULT – Original Submission Worldwide Trends in Multi-arterial Coronary Artery Bypass Grafting Surgery 2004-2014: A Tale of 2 Continents Thomas A. Schwann, MD,* ,† James Tatoulis, MD, ‡ John Puskas, MD, § Mark Bonnell, MD,* David Taggart, MD, ‖ Paul Kurlansky, MD, ¶ Jeffery P. Jacobs, MD, # Vinod H. Thourani, MD,** Sean O’Brien, PhD, †† Amelia Wallace, PhD, †† Milo C. Engoren, MD, ‡‡ Robert F. Tranbaugh, MD, §§ and Robert H. Habib, PhD ‖‖ Recent evidence shows that multi-arterial coronary artery bypass grafting (MABG) based on bilateral internal thoracic (BITA) or left internal thoracic (LITA) and radial artery (RA) improves long-term outcomes compared with single arterial coronary artery bypass grafting (SABG) (LITA + saphenous vein graft). How this evidence affected the worldwide use of MABG, if at all, is not well defined. Accordingly, we report 10-year temporal trends of MABG utilization from 2 continents. A study population of 1,683,434 non-emergent, primary, isolated LITA-based coronary artery bypass grafting (CABG) (≥2 grafts) pa- tients was derived from the Society of Thoracic Surgeons (STS) (1,307,528 (79.5%) of 1,644,388 isolated CABG; total 1179 centers) and the Australia New Zealand Cardiothoracic (ANZ) Databases (34,213 (87%) of 39,046 iso- lated CABG; 24 centers) between 2004 and 2014. Patients were excluded based on the following: (1) no LITA, (2) if arterial grafts were other than RA or ITA, or (3) if grafting data were missing. The 3 MABG groups were LITA + RA, BITA, and BITA + RA, each with or without supplemental vein grafts. Graft- ing trends and their associated patient demographics were analyzed. SABG (89.3% STS, 51.4% ANZ) was the most common grafting strategy. MABG was most frequently accomplished by LITA + RA: (STS: 6.1%; ANZ: 42.6%), followed by BITA: (STS: 4.1%; ANZ: 4.3%), while ≥3 (BITA + RA) was rare in the STS (0.5%), but more common in ANZ (5.9%). In the STS, between 2004 and 2014, SABG rates systematically increased from 85.2% to 91.7%, BITA grafting was essentially unchanged from 3.6% to 4.3%, while RA use de- creased systematically from 10.5% to 3.7%. In the ANZ, SABG rates increased from 17.3% to 51.4%, BITA grafting decreased from 6.3% to 3.6%, while RA *Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio † Department of Surgery, Mercy Saint Vincent Medical Center, Toledo, Ohio ‡ Department of Surgery, University of Melbourne, Parkville, Australia § Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York ‖ Department of Cardiovascular Surgery, University of Oxford, Oxford, UK ¶ Department of Surgery, Columbia University, New York, New York # Department of Surgery, Johns Hopkins University, Baltimore, Maryland **Department of Surgery, Emory University, Atlanta, Georgia †† Duke Clinical Research Center, Duke University, Durham, North Carolina ‡‡ Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan §§ St. Vincent Department of Surgery, Weill Cornell Medical College, New York, New York ‖‖ Society of Thoracic Surgeons Research Center, Chicago, Illinois All authors have no conflicts of interest to disclose. Research funded by departmental and institutional funds. Presented at the Association for Thoracic Surgery Annual Meeting, Baltimore, Maryland (May 14-18, 2016). Address reprint requests to Thomas A. Schwann, MD, Department of Surgery, University of Toledo College of Medicine, 3000 Arlington Ave, Toledo, OH 43614. E-mail: thomas.schwann@utoledo.edu Annual trends in grafting (2004-2014) in Society of Thoracic Surgeons and Australia-New Zealand Databases. Central Message Multi-arterial coronary artery bypass grafting (MABG) remains underutilized, with a counterintuitive decreasing rate of MABG between 2004 and 2014 despite overwhelm- ingly consistent data of improved long-term survival associated with MABG. Perspective Statement Recent evidence shows that multi-arterial cor- onary artery bypass grafting (MABG) based on bilateral internal thoracic (BITA) or left inter- nal thoracic (LITA) and radial artery (RA) improves long-term outcomes compared with single arterial coronary artery bypass grafting (SABG) (LITA + saphenous vein graft). How this evidence affected the worldwide use of MABG is not well defined. Accordingly, we report a 10- year temporal trend of MABG utilization from 2 continents. 1043-0679/$-see front matter © 2017 Elsevier Inc. All rights reserved. 1 http://dx.doi.org/10.1053/j.semtcvs.2017.05.018