# Bilateral internal thoracic artery grafting × Ten-year overall survival after CABG — ART efficacy and sternal-harm evidence sheet Verdict 2917 · Evidence Check Stored-material review date: Not recorded Original evidence cut-off: 2026-08-26 Review-criteria version: 1.0 Public page/material preparation date: 2026-10-10 Clinical papers were not read directly; existing review summaries were checked. No new clinical-literature search was performed. Unverified does not mean that research is absent or that there is no effect. ## Assessment scope - Population: ART participants undergoing CABG; original detailed eligibility and baseline information not read - Ingredient, formulation and route: Historical surgical conditions of assignment to bilateral internal thoracic artery grafting - Dose: Original details of the actual procedure, technique, devices, conduits and exposure not read; no guidance on individual implementation, selection or treatment - Comparator: Assignment to a single internal thoracic artery; distinguish the original 14% crossover and 22% additional radial-artery grafting - Measured outcome: Original ten-year overall-survival question and all-cause mortality endpoint; sternal wounds considered separately - Duration: Distinguish ten-year survival, mortality and censoring from the unverified original wound-observation window - Questions outside this scope: Converting the MAIN claim into a subclaim or a new split; Interpreting a null result or CI as an exact zero effect, equivalence or absence of all harm; Independently adding participants or reports shared across other comparative verdicts or time points; Calculating new survival rates, event counts or differences from mortality rates; Recommendations on individual procedures, surgery, devices, treatment selection or implementation ## Checklist items ### N01 · Were the selected claim and existing verdict record distinguished? Verification status: Partly verified Reading scope: Summary read; external materials and linked targets not read - Current findings: The selected claim is improved ten-year overall survival after CABG; the root grade D, score 34, Warning and axes E−/I2/B0/C0 are preserved. Distinguish the existing history from the current verdict record. - Why unverified: Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not turn the MAIN claim into a subclaim or introduce parent-inheritance or missing-subclaim-score explanations. Preserve the actual values, presence or absence and original verdict without a new verdict or split. - Reason for missing information: Do not turn the MAIN claim into a subclaim or introduce parent-inheritance or missing-subclaim-score explanations. Preserve the actual values, presence or absence and original verdict without a new verdict or split. - Required materials and conditions: Preservation of the existing claim wording, verdict values, history and empty values - Materials to obtain first: Do not turn the MAIN claim into a subclaim or introduce parent-inheritance or missing-subclaim-score explanations. Preserve the actual values, presence or absence and original verdict without a new verdict or split. - Further research: Link original materials and decisions to the actual MAIN question and root verdict record. - Conditions for verification: Preservation of the existing claim wording, verdict values, history and empty values - Why this condition is needed: An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim - Application exceptions: Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety. - Remaining uncertainty: Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification - Referenced methods: Selected claim: Improved ten-year overall survival after CABG - Related sources: R01 ### N02 · What are the CABG population, baseline and eligibility, and how do they differ from other coronary questions? Verification status: Partly verified Reading scope: Summary read; external materials and linked targets not read - Current findings: ART is a surgical-technique trial asking whether to use bilateral internal thoracic arteries during CABG. - Why unverified: Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not replace this with PCI-versus-CABG questions in diabetic multivessel or left-main disease. Age, eligibility, exclusions, baseline and institution-specific surgical details were not read. - Reason for missing information: Do not replace this with PCI-versus-CABG questions in diabetic multivessel or left-main disease. Age, eligibility, exclusions, baseline and institution-specific surgical details were not read. - Required materials and conditions: Original CABG eligibility, baseline, institutions, surgical conditions and denominators - Materials to obtain first: Do not replace this with PCI-versus-CABG questions in diabetic multivessel or left-main disease. Age, eligibility, exclusions, baseline and institution-specific surgical details were not read. - Further research: Obtain original population, eligibility, baseline, institution and surgical-condition materials. - Conditions for verification: Original CABG eligibility, baseline, institutions, surgical conditions and denominators - Why this condition is needed: An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim - Application exceptions: Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety. - Remaining uncertainty: Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification - Referenced methods: Selected claim: Improved ten-year overall survival after CABG - Related sources: R01, R02, R03 ### N03 · What are the assigned comparison and actual techniques of bilateral versus single internal thoracic artery grafting? Verification status: Partly verified Reading scope: Summary read; external materials and linked targets not read - Current findings: ART assigned bilateral versus single internal thoracic artery grafting; actual surgical crossover and additional radial-artery grafting in the single group occurred. - Why unverified: Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not turn the graft-number question into the effect of CABG itself, superiority of all arterial grafting, or surgical-method and selection guidance. Conduit, surgical and concurrent-management details were not read. - Reason for missing information: Do not turn the graft-number question into the effect of CABG itself, superiority of all arterial grafting, or surgical-method and selection guidance. Conduit, surgical and concurrent-management details were not read. - Required materials and conditions: Original assignment, actual grafting, common CABG procedures, other conduits and concurrent treatment - Materials to obtain first: Do not turn the graft-number question into the effect of CABG itself, superiority of all arterial grafting, or surgical-method and selection guidance. Conduit, surgical and concurrent-management details were not read. - Further research: Obtain original assignment, actual techniques, other conduits, concurrent management and change materials. - Conditions for verification: Original assignment, actual grafting, common CABG procedures, other conduits and concurrent treatment - Why this condition is needed: An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim - Application exceptions: Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety. - Remaining uncertainty: Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification - Referenced methods: Selected claim: Improved ten-year overall survival after CABG - Related sources: R01 ### N04 · Were the 3,102 participants distinguished from original ten-year denominators and death counts? Verification status: Partly verified Reading scope: Summary read; external materials and linked targets not read - Current findings: The original source records 3,102 participants and ten-year mortality of 20.3% versus 21.2%. - Why unverified: Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not calculate group allocation numbers, death counts, risk sets or new proportions and totals. Do not add multiple assessments or reports as independent people. - Reason for missing information: Do not calculate group allocation numbers, death counts, risk sets or new proportions and totals. Do not add multiple assessments or reports as independent people. - Required materials and conditions: Assignment, group-specific analysis, follow-up, censoring, events and denominators - Materials to obtain first: Do not calculate group allocation numbers, death counts, risk sets or new proportions and totals. Do not add multiple assessments or reports as independent people. - Further research: Obtain original group-specific assignment, analysis, follow-up, risk sets and event tables. - Conditions for verification: Assignment, group-specific analysis, follow-up, censoring, events and denominators - Why this condition is needed: An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim - Application exceptions: Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety. - Remaining uncertainty: Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification - Referenced methods: Selected claim: Improved ten-year overall survival after CABG - Related sources: R01 ### N05 · Were the overall-survival question and actual ten-year all-cause mortality endpoint distinguished? Verification status: Partly verified Reading scope: Summary read; external materials and linked targets not read - Current findings: The original effect question is improved ten-year overall survival, and the original primary endpoint is all-cause death at ten years. - Why unverified: Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not convert death proportions into new survival rates or substitute cardiovascular or sternal mortality, healing or functional improvement. Original follow-up reference points and cause-specific ascertainment details were not read. - Reason for missing information: Do not convert death proportions into new survival rates or substitute cardiovascular or sternal mortality, healing or functional improvement. Original follow-up reference points and cause-specific ascertainment details were not read. - Required materials and conditions: Original death definition, period, overall survival, original denominator and ascertainment - Materials to obtain first: Do not convert death proportions into new survival rates or substitute cardiovascular or sternal mortality, healing or functional improvement. Original follow-up reference points and cause-specific ascertainment details were not read. - Further research: Obtain original death and survival definitions, time points, ascertainment and denominators. - Conditions for verification: Original death definition, period, overall survival, original denominator and ascertainment - Why this condition is needed: An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim - Application exceptions: Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety. - Remaining uncertainty: Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification - Referenced methods: Selected claim: Improved ten-year overall survival after CABG - Related sources: R01 ### N06 · Are 20.3%/21.2%, HR 0.96, the 95% CI and −0.9 percentage points preserved? Verification status: Partly verified Reading scope: Summary read; external materials and linked targets not read - Current findings: Ten-year mortality was 20.3% with bilateral versus 21.2% with single grafting; HR 0.96 (95% CI 0.79–1.17), with an original absolute difference of −0.9 percentage points. - Why unverified: Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not fill in or calculate original P values, an absolute-difference CI, adjusted models, death counts, new survival rates or NNT. - Reason for missing information: Do not fill in or calculate original P values, an absolute-difference CI, adjusted models, death counts, new survival rates or NNT. - Required materials and conditions: Original group order, HR, CI, absolute difference, model and denominators - Materials to obtain first: Do not fill in or calculate original P values, an absolute-difference CI, adjusted models, death counts, new survival rates or NNT. - Further research: Obtain original time-to-event effects, group risk sets, models, tests and CI. - Conditions for verification: Original group order, HR, CI, absolute difference, model and denominators - Why this condition is needed: An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim - Application exceptions: Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety. - Remaining uncertainty: Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification - Referenced methods: Selected claim: Improved ten-year overall survival after CABG - Related sources: R01 ### N07 · What are the null result, CI tails allowing meaningful benefit and harm, and the original warning? Verification status: Partly verified Reading scope: Summary read; external materials and linked targets not read - Current findings: The original reader answer records remaining possibilities of meaningful benefit and harm, without establishing absence of benefit. The original grade D, score 34 and Warning are preserved. - Why unverified: Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not interpret an HR near the null or a null result as an exact zero effect, equivalence or exclusion of all clinical effects. No new MCID, power calculation or examples are supplied. - Reason for missing information: Do not interpret an HR near the null or a null result as an exact zero effect, equivalence or exclusion of all clinical effects. No new MCID, power calculation or examples are supplied. - Required materials and conditions: Original interval, precision, efficacy, harm and clinical boundaries - Materials to obtain first: Do not interpret an HR near the null or a null result as an exact zero effect, equivalence or exclusion of all clinical effects. No new MCID, power calculation or examples are supplied. - Further research: Obtain original clinical boundaries, precision and separate efficacy and harm interpretations. - Conditions for verification: Original interval, precision, efficacy, harm and clinical boundaries - Why this condition is needed: An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim - Application exceptions: Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety. - Remaining uncertainty: Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification - Referenced methods: Selected claim: Improved ten-year overall survival after CABG - Related sources: R01 ### N08 · What are the 14% bilateral-to-single crossover and 22% additional radial-artery grafting in the single group? Verification status: Partly verified Reading scope: Summary read; external materials and linked targets not read - Current findings: The original record says that 14% assigned bilateral received a single graft, while 22% assigned single received a radial artery as a second arterial graft. - Why unverified: Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not add these two crossovers or convert them into causal effects of the actual surgical groups. Do not newly classify them as allocation failure or completer analysis; the degree of contrast dilution, reasons and denominators were not read. - Reason for missing information: Do not add these two crossovers or convert them into causal effects of the actual surgical groups. Do not newly classify them as allocation failure or completer analysis; the degree of contrast dilution, reasons and denominators were not read. - Required materials and conditions: Assignment, actual surgery, crossover, adherence, periods and original denominators - Materials to obtain first: Do not add these two crossovers or convert them into causal effects of the actual surgical groups. Do not newly classify them as allocation failure or completer analysis; the degree of contrast dilution, reasons and denominators were not read. - Further research: Obtain original crossover, adherence, actual techniques, reasons, denominators, effects of interest and sensitivity analyses. - Conditions for verification: Assignment, actual surgery, crossover, adherence, periods and original denominators - Why this condition is needed: An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim - Application exceptions: Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety. - Remaining uncertainty: Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification - Referenced methods: Selected claim: Improved ten-year overall survival after CABG - Related sources: R01 ### N09 · Were ITT, as-treated analyses, observational associations and the dilution explanation distinguished? Verification status: Partly verified Reading scope: Summary read; external materials and linked targets not read - Current findings: The original text preserves the ITT principle and treatment-contrast dilution, and distinguishes long-term observational benefits from randomized effects. - Why unverified: Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not conclude that crossover explains all null findings or newly derive survival superiority for actual-treatment groups. Per-protocol and as-treated model details were not read. - Reason for missing information: Do not conclude that crossover explains all null findings or newly derive survival superiority for actual-treatment groups. Per-protocol and as-treated model details were not read. - Required materials and conditions: Assignment effect of interest, actual-treatment models, confounding and sensitivity analyses - Materials to obtain first: Do not conclude that crossover explains all null findings or newly derive survival superiority for actual-treatment groups. Per-protocol and as-treated model details were not read. - Further research: Obtain original effects of interest, actual-treatment analyses, confounding, sensitivity analyses and denominators. - Conditions for verification: Assignment effect of interest, actual-treatment models, confounding and sensitivity analyses - Why this condition is needed: An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim - Application exceptions: Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety. - Remaining uncertainty: Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification - Referenced methods: Selected claim: Improved ten-year overall survival after CABG - Related sources: R01 ### N10 · Is censoring of 71 participants (2.3%) with missing ten-year vital status the same as attrition? Verification status: Partly verified Reading scope: Summary read; external materials and linked targets not read - Current findings: The original text records that 71 participants (2.3%) with missing ten-year vital status were censored in survival analysis and were not counted as attrition. - Why unverified: Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not subtract the 71 participants as new exclusions or a completer analysis, or certify censoring as zero missingness or complete follow-up. Censoring times, assumptions, original effects and group mapping were not read. - Reason for missing information: Do not subtract the 71 participants as new exclusions or a completer analysis, or certify censoring as zero missingness or complete follow-up. Censoring times, assumptions, original effects and group mapping were not read. - Required materials and conditions: Original vital status, missingness, censoring times, reasons and sensitivity analyses - Materials to obtain first: Do not subtract the 71 participants as new exclusions or a completer analysis, or certify censoring as zero missingness or complete follow-up. Censoring times, assumptions, original effects and group mapping were not read. - Further research: Obtain original group-specific censoring, times, reasons, assumptions, sensitivity analyses and risk sets. - Conditions for verification: Original vital status, missingness, censoring times, reasons and sensitivity analyses - Why this condition is needed: An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim - Application exceptions: Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety. - Remaining uncertainty: Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification - Referenced methods: Selected claim: Improved ten-year overall survival after CABG - Related sources: R01 ### N11 · Were secure web allocation, unmasked surgery, event adjudication and the B0 history distinguished? Verification status: Partly verified Reading scope: Summary read; external materials and linked targets not read - Current findings: The original text records secure web randomization, inability to mask surgeons and patients, adjudication of all events including adverse events, and ITT as the historical basis for B0. - Why unverified: Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not certify event adjudication as adjudicator blinding absent from the source or as a new review establishing absence of all bias. - Reason for missing information: Do not certify event adjudication as adjudicator blinding absent from the source or as a new review establishing absence of all bias. - Required materials and conditions: Allocation, concealment, surgeons and patients, assessment, adjudication and analysis - Materials to obtain first: Do not certify event adjudication as adjudicator blinding absent from the source or as a new review establishing absence of all bias. - Further research: Obtain original allocation, adjudication, assessor, analyst and data-collection procedures. - Conditions for verification: Allocation, concealment, surgeons and patients, assessment, adjudication and analysis - Why this condition is needed: An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim - Application exceptions: Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety. - Remaining uncertainty: Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification - Referenced methods: Selected claim: Improved ten-year overall survival after CABG - Related sources: R01 ### N12 · What was accessed regarding registration, prespecified ten-year mortality, subgroups and hierarchy? Verification status: Partly verified Reading scope: Summary read; external materials and linked targets not read - Current findings: The history of the original registration identifier ISRCTN46552265 and its consistency with prespecified ten-year all-cause mortality is preserved. - Why unverified: Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. No new registration or plan reading was performed. Do not create prespecified subgroups, α, multiplicity, changes or test P values for specific populations or actual techniques. - Reason for missing information: No new registration or plan reading was performed. Do not create prespecified subgroups, α, multiplicity, changes or test P values for specific populations or actual techniques. - Required materials and conditions: Original registration, protocol, SAP, prespecified endpoints, changes and multiplicity - Materials to obtain first: No new registration or plan reading was performed. Do not create prespecified subgroups, α, multiplicity, changes or test P values for specific populations or actual techniques. - Further research: Obtain original registration, plans, hierarchy, subgroups, interactions and changes. - Conditions for verification: Original registration, protocol, SAP, prespecified endpoints, changes and multiplicity - Why this condition is needed: An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim - Application exceptions: Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety. - Remaining uncertainty: Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification - Referenced methods: Selected claim: Improved ten-year overall survival after CABG - Related sources: R01 ### N13 · Were sternal wounds of 3.5%/1.9%, efficacy, harm and periods distinguished? Verification status: Partly verified Reading scope: Summary read; external materials and linked targets not read - Current findings: The original source says that sternal wound complications increased to 3.5% with bilateral versus 1.9% with single grafting. This is a separate harm outcome from ten-year mortality. - Why unverified: Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not fill in a ten-year wound-observation period or calculate original event counts, CI, P values, RR, NNH or differences. Definitions, collection, relatedness and original denominators were not read. - Reason for missing information: Do not fill in a ten-year wound-observation period or calculate original event counts, CI, P values, RR, NNH or differences. Definitions, collection, relatedness and original denominators were not read. - Required materials and conditions: Wound definition, severity and collection, people and events, periods and denominators - Materials to obtain first: Do not fill in a ten-year wound-observation period or calculate original event counts, CI, P values, RR, NNH or differences. Definitions, collection, relatedness and original denominators were not read. - Further research: Obtain original wound definitions, periods, group-specific people, events, denominators, CI and tests. - Conditions for verification: Wound definition, severity and collection, people and events, periods and denominators - Why this condition is needed: An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim - Application exceptions: Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety. - Remaining uncertainty: Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification - Referenced methods: Selected claim: Improved ten-year overall survival after CABG - Related sources: R01 ### N14 · What are the increased wound harm and gaps concerning rare or other harms and long-term safety? Verification status: Unverified Reading scope: Summary read; external materials and linked targets not read - Current findings: The original safety warning and increased sternal wounds are preserved, together with the original description of adjudication of all events. - Why unverified: Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not extend the warning to established harm of every kind or established harm to survival. Other harms, reoperations, rare events, relatedness and original exposure details were not read. - Reason for missing information: Do not extend the warning to established harm of every kind or established harm to survival. Other harms, reoperations, rare events, relatedness and original exposure details were not read. - Required materials and conditions: Other harms, collection, actual techniques, relatedness, periods and denominators - Materials to obtain first: Do not extend the warning to established harm of every kind or established harm to survival. Other harms, reoperations, rare events, relatedness and original exposure details were not read. - Further research: Obtain original overall-harm, actual-technique, collection, relatedness, period and denominator materials. - Conditions for verification: Other harms, collection, actual techniques, relatedness, periods and denominators - Why this condition is needed: An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim - Application exceptions: Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety. - Remaining uncertainty: Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification - Referenced methods: Selected claim: Improved ten-year overall survival after CABG - Related sources: R01 ### N15 · What is the information level for MRC/BHF funding, in-kind support, affiliations and external analysis? Verification status: Partly verified Reading scope: Summary read; external materials and linked targets not read - Current findings: UK MRC and British Heart Foundation support and the original I2 are preserved. - Why unverified: Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not turn public funding into certification of no company in-kind support, no employees or fully independent analysis. Details of each disclosed role were not read. - Reason for missing information: Do not turn public funding into certification of no company in-kind support, no employees or fully independent analysis. Details of each disclosed role were not read. - Required materials and conditions: Public or nonprofit funding, devices, in-kind support, affiliations, analysis and writing - Materials to obtain first: Do not turn public funding into certification of no company in-kind support, no employees or fully independent analysis. Details of each disclosed role were not read. - Further research: Obtain original disclosures on cash, in-kind support, affiliations, design, analysis and writing. - Conditions for verification: Public or nonprofit funding, devices, in-kind support, affiliations, analysis and writing - Why this condition is needed: An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim - Application exceptions: Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety. - Remaining uncertainty: Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification - Referenced methods: Selected claim: Improved ten-year overall survival after CABG - Related sources: R01 ### N16 · What are the 1822/2859 cross-citations and relationships with the same ART report and follow-up? Verification status: Partly verified Reading scope: Summary read; external materials and linked targets not read - Current findings: Verdict 1822 concerns CABG strategy in diabetic multivessel disease, and 2859 concerns PCI versus CABG in left-main disease; both differ from ART's graft-number question. - Why unverified: Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Linked targets and original papers were not newly read or used as direct replication or additional participants. Do not count the same ART ten-year report or assessments as new independent trials; independent counts and total participants remain null. - Reason for missing information: Linked targets and original papers were not newly read or used as direct replication or additional participants. Do not count the same ART ten-year report or assessments as new independent trials; independent counts and total participants remain null. - Required materials and conditions: Reports, related verdicts, populations, comparators, shared cohorts and independence relationships - Materials to obtain first: Linked targets and original papers were not newly read or used as direct replication or additional participants. Do not count the same ART ten-year report or assessments as new independent trials; independent counts and total participants remain null. - Further research: Link new reports using original identifiers, shared cohorts and time points, and separate questions. - Conditions for verification: Reports, related verdicts, populations, comparators, shared cohorts and independence relationships - Why this condition is needed: An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim - Application exceptions: Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety. - Remaining uncertainty: Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification - Referenced methods: Selected claim: Improved ten-year overall survival after CABG - Related sources: R01, R02, R03 ### N17 · What are the applicability gaps for observational benefits, other techniques or populations and longer periods? Verification status: Unverified Reading scope: Summary read; external materials and linked targets not read - Current findings: The original core question is ten-year overall survival under assignment to bilateral internal thoracic arteries. The source treats observational advantages separately. - Why unverified: Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not transfer effects from other conduits, selected subgroups, actual surgical groups or other CABG indications, or create guidance on surgical selection, implementation or treatment. - Reason for missing information: Do not transfer effects from other conduits, selected subgroups, actual surgical groups or other CABG indications, or create guidance on surgical selection, implementation or treatment. - Required materials and conditions: Original follow-up and direct efficacy and harm by population, conduit and technique - Materials to obtain first: Do not transfer effects from other conduits, selected subgroups, actual surgical groups or other CABG indications, or create guidance on surgical selection, implementation or treatment. - Further research: Obtain direct efficacy, harm, plans and denominators by population, technique, exposure and period. - Conditions for verification: Original follow-up and direct efficacy and harm by population, conduit and technique - Why this condition is needed: An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim - Application exceptions: Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety. - Remaining uncertainty: Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification - Referenced methods: Selected claim: Improved ten-year overall survival after CABG - Related sources: R01 ### N18 · Were the summary, paper and related-verdict URLs, registration identifier and actual access distinguished? Verification status: Partly verified Reading scope: Summary read; external materials and linked targets not read - Current findings: The entire stored summary of the designated existing verdict was read for preparation, and the original source links and registration identifier were linked. - Why unverified: Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. External abstracts, full texts, registrations, protocols, SAP and related-verdict targets were not read, and no separate link testing was performed. Do not create new URLs, DOI or original-study information. - Reason for missing information: External abstracts, full texts, registrations, protocols, SAP and related-verdict targets were not read, and no separate link testing was performed. Do not create new URLs, DOI or original-study information. - Required materials and conditions: Original bibliography, URLs, registration, material-specific access and cross-citations - Materials to obtain first: External abstracts, full texts, registrations, protocols, SAP and related-verdict targets were not read, and no separate link testing was performed. Do not create new URLs, DOI or original-study information. - Further research: Link user-provided original materials by material type and actual access. - Conditions for verification: Original bibliography, URLs, registration, material-specific access and cross-citations - Why this condition is needed: An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim - Application exceptions: Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety. - Remaining uncertainty: Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification - Referenced methods: Selected claim: Improved ten-year overall survival after CABG - Related sources: R01, R02, R03 ### N19 · Were MAIN languages, dates, corrections, empty arrays, false/null, empty values and candidate history preserved? Verification status: Partly verified Reading scope: Summary read; external materials and linked targets not read - Current findings: Preserve 2026-08-26, empty corrections/subclaims arrays, the empty deliberation string, root grade/score/safety/axes, Korean and English, false/null and empty values unchanged. - Why unverified: Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. This root record is not a case of missing subclaim scores or parent inheritance. Original verification and path checks, B0, support and safety assessments are historical, not a completed current review. Original candidate pending/eligible states are also historical. - Reason for missing information: This root record is not a case of missing subclaim scores or parent inheritance. Original verification and path checks, B0, support and safety assessments are historical, not a completed current review. Original candidate pending/eligible states are also historical. - Required materials and conditions: Original root verdict, Korean and English, cut-off, corrections, history and presence or absence - Materials to obtain first: This root record is not a case of missing subclaim scores or parent inheritance. Original verification and path checks, B0, support and safety assessments are historical, not a completed current review. Original candidate pending/eligible states are also historical. - Further research: Link user materials and decisions to full original preservation and separate events. - Conditions for verification: Original root verdict, Korean and English, cut-off, corrections, history and presence or absence - Why this condition is needed: An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim - Application exceptions: Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety. - Remaining uncertainty: Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification - Referenced methods: Selected claim: Improved ten-year overall survival after CABG - Related sources: R01 ## Evidence and sources ### R01 Taggart DP, et al. N Engl J Med. 2019;380:437-446. PMID: 30699314. [PubMed](https://pubmed.ncbi.nlm.nih.gov/30699314/) Materials actually read: Summary read; external materials and linked targets not read Findings recorded in the summary: 20.3% versus 21.2%; HR 0.96 (95% CI 0.79–1.17); absolute difference −0.9 percentage points Record level: Existing review summary; external papers were not compared during this preparation Independent replication: Family IDs link relationships and do not certify independent counts; reports, periods, events, institutions, cross-citations and participants are not independently added. F01: the same RCT, efficacy, harm and cohort shared by the designated MAIN claim. F02: an existing-verdict cross-citation concerning another population or comparator; target not read and independent replication not certified. F03: an existing-verdict cross-citation concerning another population or comparator; target not read and independent replication not certified. | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Stored existing review summary | Original URL preserved | Summary read | Summary read | Report-specific summary links within the same stored summary | | External abstract | Original URL preserved | Not read | Not read | External materials and related-verdict targets not read; a URL does not certify reading or review | | External full paper | No separate original URL | Not read | Not read | External materials and related-verdict targets not read; a URL does not certify reading or review | | External registration | No separate original URL | Not read | Not read | External materials and related-verdict targets not read; a URL does not certify reading or review | | External protocol and SAP | No separate original URL | Not read | Not read | External materials and related-verdict targets not read; a URL does not certify reading or review | ### R02 Chamgap 1822 CABG × Diabetic multivessel disease [Official source](https://chamgap.com/verdicts/heart/cabg-diabetes-multivessel-coronary-disease-major-events/) Materials actually read: Summary read; external materials and linked targets not read Findings recorded in the summary: Although also concerning CABG, this asks about treatment strategy in diabetic multivessel disease. Record level: Original cross-citation concerning another population or comparator; not direct MAIN evidence or independent replication Independent replication: Family IDs link relationships and do not certify independent counts; reports, periods, events, institutions, cross-citations and participants are not independently added. F01: the same RCT, efficacy, harm and cohort shared by the designated MAIN claim. F02: an existing-verdict cross-citation concerning another population or comparator; target not read and independent replication not certified. F03: an existing-verdict cross-citation concerning another population or comparator; target not read and independent replication not certified. | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Stored existing review summary | Original URL preserved | Summary read | Summary read | Report-specific summary links within the same stored summary | | Original related-verdict link | Original URL preserved | Not read | Not read | External materials and related-verdict targets not read; a URL does not certify reading or review | | External full paper | No separate original URL | Not read | Not read | External materials and related-verdict targets not read; a URL does not certify reading or review | | External registration | No separate original URL | Not read | Not read | External materials and related-verdict targets not read; a URL does not certify reading or review | | External protocol and SAP | No separate original URL | Not read | Not read | External materials and related-verdict targets not read; a URL does not certify reading or review | ### R03 Chamgap 2859 Stent versus CABG × Left-main disease [Official source](https://chamgap.com/verdicts/heart/everolimus-eluting-stent-pci-cabg-left-main-three-year-noninferiority/) Materials actually read: Summary read; external materials and linked targets not read Findings recorded in the summary: PCI versus CABG is a different question from comparing numbers of graft vessels. Record level: Original cross-citation concerning another population or comparator; not direct MAIN evidence or independent replication Independent replication: Family IDs link relationships and do not certify independent counts; reports, periods, events, institutions, cross-citations and participants are not independently added. F01: the same RCT, efficacy, harm and cohort shared by the designated MAIN claim. F02: an existing-verdict cross-citation concerning another population or comparator; target not read and independent replication not certified. F03: an existing-verdict cross-citation concerning another population or comparator; target not read and independent replication not certified. | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Stored existing review summary | Original URL preserved | Summary read | Summary read | Report-specific summary links within the same stored summary | | Original related-verdict link | Original URL preserved | Not read | Not read | External materials and related-verdict targets not read; a URL does not certify reading or review | | External full paper | No separate original URL | Not read | Not read | External materials and related-verdict targets not read; a URL does not certify reading or review | | External registration | No separate original URL | Not read | Not read | External materials and related-verdict targets not read; a URL does not certify reading or review | | External protocol and SAP | No separate original URL | Not read | Not read | External materials and related-verdict targets not read; a URL does not certify reading or review | ## Review criteria and methods These are Chamgap's own application conditions, informed by the relevant sections of official methodological guidance. They do not constitute official assessment-tool certification or a new efficacy score. - M03 [Cochrane Handbook 6.5 (2024), chapter updated 2023-08](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-03) · §3.1, §3.2.1–3.2.3, MECIR C5/C7/C13 · Clearly record the question, eligibility conditions and reasons for changes, and distinguish variations in interventions. · Existing stored methodological links reused for preparation; no current review, reassessment of methodological content or external-link testing - M04 [Cochrane Handbook 6.5.1 (2025), chapter updated 2025-03](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-04) · §4.5, §4.6.1–4.6.3, MECIR C42 · Distinguish studies from reports and link them; do not omit a study solely because results are unreported. · Existing stored methodological links reused for preparation; no current review, reassessment of methodological content or external-link testing - M08 [Cochrane Handbook 6.5 (2024), chapter updated 2019-10](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-08) · §8.1–8.2.3, Table 8.2.a · Define the outcome and effect of interest, then examine randomization, deviations, missing data, measurement and selective reporting. · Existing stored methodological links reused for preparation; no current review, reassessment of methodological content or external-link testing - M15 [Cochrane Handbook 6.5 (2024), chapter updated 2023-08](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-15) · §15.2.4, §15.3.1–15.3.3 · Distinguish effect estimates, intervals, importance and applicability. Sample size alone does not determine precision. · Existing stored methodological links reused for preparation; no current review, reassessment of methodological content or external-link testing - M19 [Cochrane Handbook 6.5 (2024), chapter updated 2019-10](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-19) · §19.1.2, §19.2.1–19.2.4 · Harm questions may require different designs, populations and follow-up from efficacy questions. Case reports do not establish incidence rates. · Existing stored methodological links reused for preparation; no current review, reassessment of methodological content or external-link testing ## What the statuses mean - Partly verified: Some information is present in the stored source, with detailed original materials still unverified; this does not mean review passed or clinical efficacy certified - Unverified: Detailed materials for the selected condition could not be established within the stored scope; this does not mean zero effect, zero studies or safety - Review incomplete: Awaiting user review - Met: Use only within the relevant condition's scope after user review; no automatic display in this preparation - Not reported: Distinguish only within materials actually read; do not turn unread external materials into unreported findings - Inaccessible: Not applied during this preparation because actual access was not tested - Not applicable: Use with a reason for non-applicability based on an explicit question boundary - Conflicting data: Judge after actual material comparison; review was not performed during this preparation - Insufficient evidence for the conditions: Do not use as a clinical grade encompassing currently unread materials ## Change history 2026-10-10 · Public page/materials 1.0. Public pages and materials were prepared from the existing 19 items. No new clinical search, verification-status changes or scoring was performed.