| Late results of conventional versus all-arterial revascularization based on internal thoracic and radial artery grafting. | |
| | |
MedLine Citation:
|
PMID: 19101262 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
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. |
| | |
Authors:
|
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 |
Affiliation:
|
Yvonne Viens, SGM, Research Institute, Saint Vincent Mercy Medical Center, Toledo, Ohio 43608, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Age Factors Aged Aged, 80 and over Cause of Death* Cohort Studies Coronary Angiography / methods Coronary Artery Bypass / methods, mortality Coronary Disease / mortality, radiography, surgery* Female Follow-Up Studies Humans Internal Mammary-Coronary Artery Anastomosis / methods, mortality* Kaplan-Meiers Estimate Male Middle Aged Postoperative Complications / mortality Probability Proportional Hazards Models Radial Artery / transplantation* Retrospective Studies Risk Assessment Severity of Illness Index Sex Factors Statistics, Nonparametric Treatment Outcome |
| Comments/Corrections | |
Comment In:
|
Ann Thorac Surg. 2009 Nov;88(5):1724-5; author reply 1725
[PMID:
19853159
]
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Sirolimus treatment for recurrent lymphangioleiomyomatosis after lung transplantation.
Next Document: Subjective Memory Symptoms in Surgical and Nonsurgical Coronary Artery Patients: 6-Year Follow-up.