Document Detail

Late results of conventional versus all-arterial revascularization based on internal thoracic and radial artery grafting.
MedLine Citation:
PMID:  19101262     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Use of one or more arterial grafts to revascularize two-vessel and three-vessel coronary artery disease has been shown to improve coronary artery bypass graft surgery (CABG) survival. Yet, the presumed long-term survival benefits of all-arterial CABG have not been quantified. METHODS: We compared propensity-adjusted 12-year survival in two contemporaneous multivessel primary CABG cohorts with all patients receiving 2 or more grafts: (1) all-arterial cohort (n = 612; 297 three-vessel disease [49%]); and (2) single internal thoracic artery (ITA) plus saphenous vein (SV) cohort (n = 4,131; 3,187 three-vessel disease [77%]). RESULTS: Early (30-day) deaths were similar for the all-arterial and ITA/SV cohorts (8 [1.30%] versus 69 [1.67%]) whereas late mortality was substantially greater for the ITA/SV cohort (85 [13.9%] versus 1,216 [29.4%]; p < 0.0001). The risk-adjusted 12-year survival was significantly better for all-arterial (with a risk ratio [RR] = 0.60; 95% confidence interval [CI]: 0.48 to 0.75; p < 0.001), but this benefit was true only for three-vessel disease (RR = 0.58; 95% CI: 0.43 to 0.78; p < 0.001) and not for two-vessel disease (RR = 0.97; 95% CI: 0.66 to 1.43; p = 0.89). The all-arterial survival benefit was also true for varying risk subcohorts: no diabetes mellitus (RR = 0.50; 95% CI: 0.37 to 0.69), diabetes mellitus (RR = 0.77; 95% CI: 0.56 to 1.07), ejection fraction 40% or greater (RR = 0.60; 95% CI: 0.45 to 0.78), and ejection fraction less than 40% (RR = 0.62; 95% CI: 0.40 to 0.98). Lastly, the multivariate analysis indicated a strong long-term effect of completeness of revascularization, particularly for all-arterial patients, so that compared with patients with two grafts, survival was significantly better when three grafts (RR = 0.54; 95% CI: 0.33 to 0.87) or four grafts (RR = 0.40; 95% CI: 0.21 to 0.76) were completed. CONCLUSIONS: All-arterial revascularization is associated with significantly better 12-year survival compared with the standard single ITA with saphenous vein CABG operation, in particular for triple-vessel disease patients. The completeness of revascularization of the underlying coronary disease is critical for maximizing the long-term benefits of arterial-only grafting.
Anoar Zacharias; Thomas A Schwann; Christopher J Riordan; Samuel J Durham; Aamir S Shah; Robert H Habib
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  87     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2008-12-22     Completed Date:  2009-01-22     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  19-26.e2     Citation Subset:  AIM; IM    
Yvonne Viens, SGM, Research Institute, Saint Vincent Mercy Medical Center, Toledo, Ohio 43608, USA.
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MeSH Terms
Age Factors
Aged, 80 and over
Cause of Death*
Cohort Studies
Coronary Angiography / methods
Coronary Artery Bypass / methods,  mortality
Coronary Disease / mortality,  radiography,  surgery*
Follow-Up Studies
Internal Mammary-Coronary Artery Anastomosis / methods,  mortality*
Kaplan-Meiers Estimate
Middle Aged
Postoperative Complications / mortality
Proportional Hazards Models
Radial Artery / transplantation*
Retrospective Studies
Risk Assessment
Severity of Illness Index
Sex Factors
Statistics, Nonparametric
Treatment Outcome
Comment In:
Ann Thorac Surg. 2009 Nov;88(5):1724-5; author reply 1725   [PMID:  19853159 ]

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