Document Detail


Late effects of radial artery versus saphenous vein grafting in patients aged 70 years or older.
MedLine Citation:
PMID:  22771490     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We aimed to determine whether the reported late survival benefit of radial artery (RA) versus saphenous vein (SV) grafting in the general coronary artery bypass graft surgery (CABG) population is maintained in elderly patients aged 70 years or older.
METHODS: We reviewed our 1996 to 2007 experience in 2,120 elderly patients (RA, n = 607; SV, n = 1,513) who underwent primary, nonsalvage CABG with multiple completed grafts including at least one internal thoracic artery (ITA) graft. Patients were excluded in case of single-vessel disease, bilateral ITA, ITA-only grafts, or concomitant valve/aortic surgery. Kaplan-Meier 12-year survival estimates were compared for 1-to-1 matched ITA/RA and ITA/SV cohorts based on a nonparsimonious RA use propensity model (48 variables).
RESULTS: The ITA/RA and ITA/SV cohorts (both, aged 75 ± 4yrs and 3.5 ± 0.8 grafts) were well matched and had identical operative mortality (2.3%; 11 of 480 each). Late survival was superior ITA/RA versus ITA/SV (p < 0.001), estimated at 85.1% versus 70.6% and 70.9% versus 50.5% for 5 and 10 years, respectively. Late survival risk ratios (95% confidence interval) for RA versus SV grafting was 0.47 (0.36 to 0.61), and the relative SV to RA death hazard was greater than 1 between 1 and 144 months.
CONCLUSIONS: The late survival results suggest that elderly (≥70 years) primary multivessel CABG patients benefit substantially when RA is used as the second conduit in combination with ITA. Indeed, compared with previously published comparisons including all age groups, the derived risk ratio indicates that the benefit for the elderly may exceed that for younger patients in the initial decade after CABG. Use of RA should not be avoided in the elderly.
Authors:
Robert H Habib; Thomas A Schwann; Milo Engoren
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2012-07-07
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  94     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-26     Completed Date:  2013-01-07     Revised Date:  2013-10-11    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1478-84     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Internal Medicine, American University of Beirut, Beirut, Lebanon. rh106@aub.edu.lb
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Artery Bypass*
Coronary Artery Disease / mortality,  surgery*
Female
Humans
Male
Radial Artery / transplantation*
Retrospective Studies
Saphenous Vein / transplantation*
Survival Rate
Time Factors
Treatment Outcome
Comments/Corrections
Comment In:
Ann Thorac Surg. 2013 Sep;96(3):1122   [PMID:  23992721 ]
Ann Thorac Surg. 2013 Sep;96(3):1122-3   [PMID:  23992720 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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