| Outcomes associated with bilateral internal thoracic artery grafting: the importance of age. | |
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MedLine Citation:
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PMID: 21958771 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: Although bilateral internal thoracic artery (BITA) grafting in coronary artery bypass grafting (CABG) is associated with low morbidity and good long-term results, controversy exists about the age after which BITA grafting is no longer beneficial. We sought to determine if such an age cutoff point exists. METHODS: The study cohort consisted of 5,601 consecutive patients from a cardiac surgery registry who underwent isolated CABG (1,038 [19%] BITA grafts, 4,029 [72%] single internal thoracic artery [SITA] grafts, 534 [10%] vein-only grafts) between 1995 and 2008. A Cox model was used to compare survival by use of bilateral, single, or no internal thoracic artery (ITA) grafts, adjusting for baseline clinical and demographic characteristics. RESULTS: Mean follow-up was 7.1 years. Patients undergoing BITA grafting had the lowest 1-year mortality (2.4% versus 4.3% SITA grafting and 8.2% vein-only grafting; p < 0.0001). Relative to SITA grafting, a crude survival benefit of 54% existed for BITA grafting (hazard ratio [HR] 0.46; 95% confidence interval [CI], 0.37 to 0.57; p < 0.0001) with worse survival for vein-only grafts (HR, 1.16; 95% CI, 0.99 to 1.37; p = 0.07). After adjustment, the benefit of BITA grafting was no longer statistically significant (HR, 0.87; 95% CI, 0.69 to 1.08; p = 0.2). However age may be an effect modifier: a spline analysis plotting HR (BITA grafting versus SITA grafting) against age suggested a potential survival advantage associated with BITA grafting in patients younger than 69.9 years. CONCLUSIONS: Bilateral internal thoracic artery grafting is a reasonable revascularization strategy in suitable patients up to age 70 years. As benefits of arterial grafting become more obvious over time, a longer period of follow-up will be needed to confirm the advantage of a BITA grafting strategy. In the meantime the BITA grafting advantage for patients older than 70 years is not clear. |
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Authors:
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Teresa M Kieser; Adriane M Lewin; Michelle M Graham; Billie-Jean Martin; P Diane Galbraith; Doreen M Rabi; Colleen M Norris; Peter D Faris; Merril L Knudtson; William A Ghali; |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 92 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2011 Oct |
Date Detail:
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Created Date: 2011-09-30 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 1269-76 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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