Improving the Quality of Coronary Artery Bypass Grafting

Official title

Quality Improvement Intervention on Utilization of Arterial Grafts for Coronary Artery Bypass Grafting

Overview

This is a healthcare quality improvement study focused on increasing the utilization of arterial grafts in isolated coronary artery bypass grafting (CABG). Evidence indicates that arterial grafts, compared with venous grafts, provide superior long-term patency, which are recommended to use by the clinical practice guidelines. In hospitals where the use of the internal mammary artery as a graft is relatively low(\<90%) among CABG patients, multiple interventions will be implemented to improve its adoption rate. In hospitals where internal mammary artery graft utilization is already high(≥90%), various interventions will be introduced to promote the use of multiple arterial grafts (defined as the use of two or more arterial conduits). The study targets healthcare professionals as the primary subjects of intervention, with no direct interventions applied to patients during the study period. Changes in the internal mammary artery graft utilization rate and the multiple arterial graft utilization rate before and after the intervention will serve as the primary endpoints for evaluating intervention effectiveness in the two types of hospitals, respectively.

Interventions

• Behavioral Interventions for healthcare professionals in hospitals with low usage rates
  Hospitals with low usage rates aim to improve internal mammary artery graft utilization through interventions including education, theoretical training, technical training, conference exchanges, and regular feedback on quality monitoring results.
• Behavioral Interventions for healthcare professionals in hospitals with high usage rates
  Hospitals with already high usage rates focus on increasing multi-arterial graft usage rates through similar intervention methods such as education, theoretical training, technical training, conference exchanges focus on multi-arterial graft use. The usage rates of multi-arterial graft for each hospital will be regular feed backed.

Primary outcome measures

• Hospitals with low usage rates of internal mammary artery: internal mammary artery graft utilization rate [Time frame: Duration of hospital stay(from date of admission to date of discharge)]
• Hospitals with high usage rates of internal mammary artery: multiple arterial graft utilization rate [Time frame: Duration of hospital stay(from date of admission to date of discharge)]

Secondary outcome measures (1)

• In-hospital all-cause mortality rate [Time frame: Duration of hospital stay(from date of admission to date of discharge)]

Eligibility criteria

Patients whose data used to monitor the quality

Inclusion criteria

Aged ≥ 18 years old； Indicated for CABG and undergoing CABG.

Exclusion criteria

History of prior CABG; Concurrent other cardiac surgeries on the day of CABG; Malignant tumor or life expectancy < 1 year;

• 50% stenosis of left subclavian artery; Pregnant women; Individuals diagnosed with mental illness or cognitive impairment (International Classification of Diseases-10 codes F01-F99); Patients considered by the investigator to have other factors unsuitable for inclusion.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Health services research

Study locations

Center list to be confirmed — check the primary protocol.

Identifiers

NCT: NCT07377149 · 2025-2849 · 2025ZD0546704

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗