Abstract
OBJECTIVE: The influence of socioeconomic status on the decision to use bilateral internal mammary artery (BIMA) grafting versus single IMA (SIMA) grafting remains uncertain. In this study, we examine the association between Distressed Communities Index scores and the decision to use BIMA grafting. METHODS: This multicenter retrospective study includes patients who underwent primary coronary artery bypass grafting with BIMA or SIMA between 2015 and 2024. Patients with 1 distal anastomosis and without an IMA graft were excluded. The Distressed Communities Index is a validated, zip code-based metric that reflects socioeconomic distress using 7 indicators, with higher scores indicating greater distress. It was used to assess the association between socioeconomic factors and both the likelihood of receiving BIMA grafting and postoperative outcomes. RESULTS: Of 17,110 patients, 13,692 patients (80.0%) received SIMA grafting, whereas 3418 patients (20.0%) received BIMA grafting. The median age was different between 2 groups (63.0 years; range, 56.0-70.0 years vs 68.0 years; range, 61.0-74.0 years; P < .001), and BIMA was more frequently used in patients with fewer comorbidities than SIMA (all P values < .05). The median Distressed Communities Index score was 45.80 (range, 24.29-70.63) in BIMA and 44.03 (range, 23.39-68.47) in SIMA grafting (P < .001). Multivariable logistic regression revealed that Distressed Communities Index score was associated with the likelihood of receiving BIMA grafting (odds ratio, 0.997; 95% CI, 0.995-0.99; P < .001), but not with any postoperative outcomes (all P values > .05). CONCLUSIONS: Patients from more distressed communities are less likely to receive BIMA grafting. This suggests that surgeons may unknowingly consider socioeconomic factors as part of their decision making for BIMA grafting.