Long-term propensity analysis of a second arterial graft–internal thoracic artery versus radial artery–in coronary artery bypass surgery
Ryoma Oda3, Kan Kajimoto3, Taira Yamamoto2, Hiroaki Hata3, Atsumi Oishi3, Yuki Kamikawa3, Daisuke Endo1, Akie Shimada2, Nishida Kosuke1, Lee Jiyoung1, Yuichiro Sato1, Shizuyuki Dohi2, Tohru Asai1, Minoru Tabata1, Atushi Amano1
1Cardiovascular surgery, Juntendo University Hospital, Tokyo, Japan, 2Cardiovascular surgery, Juntendo Nerima Hospital, Tokyo, Japan, 3Cardiovascular surgery, Juntendo Shizuoka Hospital, Izunokuni, Japan
Objective: Conventionally, we use arterial grafts for left circumflex (LCx) artery revascularization in patients with good life expectancy. However, the long-term results of coronary artery bypass graft (CABG) using multiarterial grafts, such as the internal thoracic artery (ITA) or radial artery (RA) as a second arterial graft, remain contentious. This study aimed to compare the long-term results of LCx revascularization with ITA versus RA.
Methods: Patients undergoing primary isolated CABG for the left anterior descending (LAD) and LCx arteries between 2002 and 2012 were retrospectively reviewed, of which, those undergoing LCx revascularization using the ITA or RA were included in this analysis. A propensity score-matched analysis was performed to compare the two groups for their long-term outcomes—all-cause death, cardiac death, major adverse cardiac events (MACE), and target vessel revascularization.
Results: We enrolled 790 patients, which included 548 (69%) and 242 (31%) in the ITA and RA groups, respectively. The ITA group had significantly more patients with diabetes mellitus (58% versus 48%; p=0.01) and chronic kidney disease (12% versus 1.7%; p<0.001). During the mean follow-up period of 10 years, long-term all-cause death (hazard ratio (HR): 0.63; 95% confidence interval (CI): 0.48–0.84) and MACE (HR: 0.72; 95% CI: 0.55–0.93) were significantly lower in the ITA group. Among the two propensity-score-matched cohorts (240 patients each), the ITA group had a significantly lower mortality rate (HR: 0.54; 95% CI: 0.38–0.76) and MACE incidence (HR: 0.73; 95% CI: 0.53–0.99) than the RA group. However, no benefits were found with the ITA graft in terms of reduction of long-term cardiac death and target vessel revascularization.
Conclusion: Despite having a greater number of patients with diabetes mellitus and chronic kidney disease in the ITA study cohort, the use of an ITA graft for LCx revascularization was associated with a lower risk of long-term all-cause death and MACE compared with RA grafts, substantiating the evidence for preferring ITA as the second arterial graft in patients with good life-expectancy.
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