Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years

被引：350

作者：

Taggart, David P. ^{[1
]}

Benedetto, Umberto ^{[4
,5
]}

Gerry, Stephen ^{[2
]}

Altman, Douglas G. ^{[2
]}

Gray, Alastair M. ^{[3
]}

Lees, Belinda ^{[1
]}

Gaudino, Mario ^{[17
]}

Zamvar, Vipin ^{[6
]}

Bochenek, Andrzej ^{[19
]}

Buxton, Brian ^{[22
]}

Choong, Cliff ^{[7
]}

Clark, Stephen ^{[8
]}

Deja, Marek ^{[20
]}

Desai, Jatin ^{[9
]}

Hasan, Ragheb ^{[12
]}

Jasinski, Marek ^{[21
]}

O'Keefe, Peter ^{[13
]}

Moraes, Fernando ^{[23
]}

Pepper, John ^{[10
,11
]}

Seevanayagam, Siven ^{[22
]}

Sudarshan, Catherine ^{[7
]}

Trivedi, Uday ^{[14
]}

Wos, Stanislaw ^{[20
]}

Puskas, John ^{[18
]}

Flather, Marcus ^{[15
,16
]}

机构：

[1] Univ Oxford, Nuffield Dept Surg Sci, John Radcliffe Hosp, Oxford, England

[2] Univ Oxford, Ctr Stat Med, Botnar Res Ctr, Oxford, England

[3] Univ Oxford, Hlth Econ Res Ctr, Nuffield Dept Populat Hlth, Oxford, England

[4] Univ Bristol, Sch Clin Sci, Bristol, Avon, England

[5] Bristol Royal Infirm & Gen Hosp, Bristol, Avon, England

[6] Royal Infirm Edinburgh NHS Trust, Dept Cardiac Surg, Edinburgh, Midlothian, Scotland

[7] Royal Papworth Hosp, Cambridge, England

[8] Freeman Rd Hosp, Dept Cardiac Surg, Newcastle, England

[9] Kings Coll Hosp London, Dept Cardiac Surg, London, England

[10] Royal Brompton Hosp, London, England

[11] Imperial Coll London, London, England

[12] Royal Infirm, Dept Cardiac Surg, Manchester, Lancs, England

[13] Univ Hosp Wales, Dept Cardiac Surg, Cardiff, S Glam, Wales

[14] Royal Sussex Cty, Dept Cardiac Surg, Brighton, E Sussex, England

[15] Univ East Anglia, Norwich Med Sch, Norwich NR4 7TJ, Norfolk, England

[16] Norfolk & Norwich Univ Hosp, Norwich, Norfolk, England

[17] New York Presbyterian Hosp, Weill Cornell Med, Dept Cardiothorac Surg, New York, NY USA

[18] Mt Sinai St Lukes, New York, NY USA

[19] Med Univ Silesia, Amer Heart Poland, Ctr Cardiovasc Res & Dev, Katowice, Poland

[20] Med Univ Silesia, Dept Cardiac Surg, Katowice, Poland

[21] Wroclaw Med Univ, Dept Cardiac & Thorac Surg, Wroclaw, Poland

[22] Austin Hlth, Dept Cardiac Surg, Melbourne, Vic, Australia

[23] Heart Inst Pernambuco, Recife, PE, Brazil

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2019年 / 380卷 / 05期

基金：

英国医学研究理事会;

关键词：

RANDOMIZED-TRIAL; BYPASS-SURGERY; MULTIPLE-ARTERIAL; POOLED ANALYSIS; LONG-TERM; REVASCULARIZATION; SURVIVAL; OUTCOMES; METAANALYSIS; INSIGHTS;

D O I：

10.1056/NEJMoa1808783

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Multiple arterial grafts may result in longer survival than single arterial grafts after coronary-artery bypass grafting (CABG) surgery. We evaluated the use of bilateral internal-thoracic-artery grafts for CABG. METHODS We randomly assigned patients scheduled for CABG to undergo bilateral or single internal-thoracic-artery grafting. Additional arterial or vein grafts were used as indicated. The primary outcome was death from any cause at 10 years. The composite of death from any cause, myocardial infarction, or stroke was a secondary outcome. RESULTS A total of 1548 patients were randomly assigned to undergo bilateral interna-lthoracic-artery grafting (the bilateral-graft group) and 1554 to undergo single internal-thoracic-artery grafting (the single-graft group). In the bilateral-graft group, 13.9% of the patients received only a single internal-thoracic-artery graft, and in the single-graft group, 21.8% of the patients also received a radial-artery graft. Vital status was not known for 2.3% of the patients at 10 years. In the intention-to-treat analysis at 10 years, there were 315 deaths (20.3% of the patients) in the bilateral-graft group and 329 deaths (21.2%) in the single-graft group (hazard ratio, 0.96; 95% confidence interval [CI], 0.82 to 1.12; P = 0.62). Regarding the composite outcome of death, myocardial infarction, or stroke, there were 385 patients (24.9%) with an event in the bilateral-graft group and 425 patients (27.3%) with an event in the single-graft group (hazard ratio, 0.90; 95% CI, 0.79 to 1.03). CONCLUSIONS Among patients who were scheduled for CABG and had been randomly assigned to undergo bilateral or single internal-thoracic-artery grafting, there was no significant between-group difference in the rate of death from any cause at 10 years in the intention-to-treat analysis. Further studies are needed to determine whether multiple arterial grafts provide better outcomes than a single internal-thoracic-artery graft.

引用

页码：437 / 446

页数：10

共 29 条

[1] Comparison of Stenting Versus Bypass Surgery According to the Completeness of Revascularization in Severe Coronary Artery Disease Patient-Level Pooled Analysis of the SYNTAX, PRECOMBAT, and BEST Trials
Ahn, Jung-Min
Park, Duk-Woo
Lee, Cheol Whan
Chang, Mineok
Cavalcante, Rafael
Sotomi, Yohei
Onuma, Yoshinobu
Tenekecioglu, Erhan
Han, Minkyu
Lee, Pil Hyung
Kang, Soo-Jin
Lee, Seung-Whan
Kim, Young-Hak
Park, Seong-Wook
Serruys, Patrick W.
Park, Seung-Jung
[J]. JACC-CARDIOVASCULAR INTERVENTIONS, 2017, 10 (14) : 1415 - 1424
[2] Off-pump versus on-pump coronary artery bypass grafting: Insights from the Arterial Revascularization Trial
Benedetto, Umberto
Altman, Douglas G.
Gerry, Stephen
Gray, Alastair
Lees, Belinda
Flather, Marcus
Taggart, David P.
[J]. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2018, 155 (04) : 1545 - +
[3] LEFT-RIGHT CHOICE IN CORONARY ARTERY BYPASS GRAFTING SURGERY Reply
Benedetto, Umberto
Angelini, Gianni D.
[J]. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2018, 155 (01) : 231 - 231
[4] Pedicled and skeletonized single and bilateral internal thoracic artery grafts and the incidence of sternal wound complications: Insights from the Arterial Revascularization Trial
Benedetto, Umberto
Altman, Douglas G.
Gerry, Stephen
Gray, Alastair
Lees, Belinda
Pawlaczyk, Rafal
Flather, Marcus
Taggart, David P.
[J]. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2016, 152 (01) : 270 - 276
[5] Searching for the second best graft for coronary artery bypass surgery: a network meta-analysis of randomized controlled trials
Benedetto, Umberto
Raja, Shahzad G.
Albanese, Alberto
Amrani, Mohammed
Biondi-Zoccai, Giuseppe
Frati, Giacomo
[J]. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2015, 47 (01) : 59 - 65
[6] Long-term and short-term outcomes of using bilateral internal mammary artery grafting versus left internal mammary artery grafting: a meta-analysis
Buttar, Sana N.
Yan, Tristan D.
Taggart, David P.
Tian, David H.
[J]. HEART, 2017, 103 (18) : 1419 - 1426
[7] Coronary bypass surgery with internal-thoracic-artery grafts - Effects on survival over a 15-year period
Cameron, A
Davis, KB
Green, G
Schaff, HV
[J]. NEW ENGLAND JOURNAL OF MEDICINE, 1996, 334 (04) : 216 - 219
[8] Coronary bypass graft fate and patient outcome: Angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years
FitzGibbon, GM
Kafka, HP
Leach, AJ
Keon, WJ
Hooper, GD
Burton, JR
[J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1996, 28 (03) : 616 - 626
[9] Generalizing results of randomized trials to clinical practice: reliability and cautions
Flather, Marcus
Delahunty, Nicola
Collinson, Julian
[J]. CLINICAL TRIALS, 2006, 3 (06) : 508 - 512
[10] Use Rate and Outcome in Bilateral Internal Thoracic Artery Grafting: Insights From a Systematic Review and Meta-Analysis
Gaudino, Mario
Bakaeen, Faisal
Benedetto, Umberto
Rahouma, Mohamed
Di Franco, Antonino
Tam, Derrick Y.
Iannaccone, Mario
Schwann, Thomas A.
Habib, Robert
Ruel, Marc
Puskas, John D.
Sabik, Joseph
Girardi, Leonard N.
Taggart, David P.
Fremes, Stephen E.
[J]. JOURNAL OF THE AMERICAN HEART ASSOCIATION, 2018, 7 (11):

← 1 2 3 →