Improving the Quality of Coronary Artery Bypass Grafting (CABG Quality)

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

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.

Study Overview

• Status: Not yet recruiting
• Conditions: Coronary Artery Bypass Grafting (CABG)
• Intervention / Treatment: Behavioral: Interventions for healthcare professionals in hospitals with low usage rates; Behavioral: Interventions for healthcare professionals in hospitals with high usage rates

• Study Type: Interventional
• Enrollment (Estimated): 8700
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Zhe Zheng, MD, PhD; Phone Number: +86 88396051; Email: zhengzhe@fuwai.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

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.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Other: Improving the utilization rate of arterial grafts for coronary artery bypass grafting; In this stepped-wedge cluster randomized trial (SW-CRT) with a self-controlled design, hospitals were categorized into two groups according to their internal mammary artery graft usage rates, thereby forming two SW-CRT. Healthcare professionals at these hospitals will receive tailored interventions. The effectiveness of each intervention is assessed by comparing the usage rates before and after implementation within each SW-CRT.

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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hospitals with low usage rates of internal mammary artery: internal mammary artery graft utilization rate	Internal mammary artery graft utilization rate: the utilization rate of at least one internal mammary artery graft in patients received isolated coronary artery bypass grafting.	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	Multiple arterial graft utilization rate: the utilization rate of two or more arterial conduits in patients received isolated coronary artery bypass grafting.	Duration of hospital stay(from date of admission to date of discharge)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
In-hospital all-cause mortality rate	The in-hospital all-cause mortality rate of patients received isolated coronary artery bypass grafting.	Duration of hospital stay(from date of admission to date of discharge)

Collaborators and Investigators

• Sponsor: China National Center for Cardiovascular Diseases
• Collaborators: The First Affiliated Hospital with Nanjing Medical University; West China Hospital; Ruijin Hospital; Shandong Provincial Hospital; Guangdong Provincial People's Hospital; Chinese Academy of Medical Sciences, Fuwai Hospital; First Affiliated Hospital of Wenzhou Medical University; The General Hospital of Northern Theater Command; Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; Central China Fuwai Hospital of Zhengzhou University

Study record dates

Study Major Dates

• Study Start (Estimated): March 15, 2026
• Primary Completion (Estimated): January 1, 2029
• Study Completion (Estimated): July 1, 2029

Study Registration Dates

• First Submitted: December 23, 2025
• First Submitted That Met QC Criteria: January 22, 2026
• First Posted (Actual): January 29, 2026

Study Record Updates

• Last Update Posted (Actual): January 29, 2026
• Last Update Submitted That Met QC Criteria: January 22, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: coronary artery bypass grafting; quality improvement; arterial graft
• Additional Relevant MeSH Terms: Investigative Techniques; Health Care Facilities Workforce and Services; Health Facilities; Methods; Health Personnel; Hospitals
• Other Study ID Numbers: 2025-2849; 2025ZD0546704 (Other Identifier: Noncommunicable Chronic Diseases-National Science and Technology Major Project)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No