Document Detail

Second internal thoracic artery versus radial artery in coronary artery bypass grafting: a long-term, propensity score-matched follow-up study.
MedLine Citation:
PMID:  21900082     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The best second arterial conduit for multiple arterial revascularization (MAR) is still a matter of debate. Previous studies on the benefit of either using the radial artery (RA) or the right internal thoracic artery (RITA) in coronary artery bypass grafting are not conclusive. The aim of our study was to compare the perioperative and long-term outcome of either RA or RITA grafts as second conduits for MAR.
METHODS AND RESULTS: A consecutive series of 1001 patients undergoing first nonemergent coronary artery bypass grafting receiving either RA or RITA as second graft for MAR between 2001 and 2010 were studied. There were 277 patients receiving a RITA and 724 patients receiving a RA in addition to a left internal thoracic artery (LITA). Concomitant saphenous vein grafts (SVG) were grafted in addition as necessary. Propensity score-matched analysis was performed to compare the 2 groups, bilateral ITA±SVG (BITA±SVG group) and the LITA+RA±SVG group relative to overall survival and major adverse cardiac and cerebrovascular events-free survival. Hazard ratios and their 95% confidence intervals were estimated by COX regression stratified on matched pairs. The incidence of perioperative major adverse cardiac and cerebrovascular events was significantly lower in the BITA±SVG group (1.4% versus 7.6%, P<0.001). Overall survival (hazard ratio 0.23; 95% confidence interval 0.066-0.81; P=0.022) and major adverse cardiac and cerebrovascular events-free survival (hazard ratio 0.18; 95% confidence interval 0.08-0.42; P<0.001) were significantly better in the BITA±SVG group compared to the LITA+RA±SVG group.
CONCLUSIONS: The results of our study provide strong evidence for the superiority of a RITA graft compared to RA as a second conduit in MAR.
Elfriede Ruttmann; Nikolaus Fischler; Adel Sakic; Orest Chevtchik; Hannes Alber; Roland Schistek; Hanno Ulmer; Michael Grimm
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article     Date:  2011-09-06
Journal Detail:
Title:  Circulation     Volume:  124     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-20     Completed Date:  2011-11-15     Revised Date:  2012-06-11    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1321-9     Citation Subset:  AIM; IM    
Department of Cardiac Surgery, Innsbruck Medical University, Austria.
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MeSH Terms
Coronary Artery Bypass / adverse effects,  methods*,  mortality
Coronary Artery Disease / mortality,  surgery*
Evidence-Based Medicine
Follow-Up Studies
Mammary Arteries / transplantation*
Middle Aged
Myocardial Revascularization / adverse effects,  methods*,  mortality
Postoperative Complications / mortality
Propensity Score
Prospective Studies
Radial Artery / transplantation*
Treatment Outcome
Comment In:
Circulation. 2012 May 1;125(17):e630; author reply e631   [PMID:  22547761 ]
Circulation. 2012 May 1;125(17):e629; author reply e631   [PMID:  22547760 ]
Circulation. 2011 Sep 20;124(12):1313-4   [PMID:  21931099 ]

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