Bilateral versus single internal-thoracic-artery grafts at 10 years

Taggart, David P., Benedetto, Umberto, Gerry, Stephen, Altman, Douglas G., Gray, Alastair M., Lees, Belinda, Gaudino, Mario, Zamvar, Vipin, Bochenek, Andrzej, Buxton, Brian, Choong, Cliff, Clark, Stephen, Deja, Marek, Desai, Jatin, Hasan, Ragheb, Jasinski, Marek, O'Keefe, Peter, Moraes, Fernando, Pepper, John, Seevanayagam, Siven, Sudarshan, Catherine, Trivedi, Uday, Wos, Stanislaw, Puskas, John and Flather, Marcus and Arterial Revascularization Trial investigators (2019) Bilateral versus single internal-thoracic-artery grafts at 10 years. New England Journal of Medicine, 380 (5). pp. 437-446. ISSN 0028-4793

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Abstract

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 internal-thoracic-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.

Item Type:	Article
Uncontrolled Keywords:	aged,cause of death,methods,mortality,female,follow-up studies,humans,intention to treat analysis,male,transplantation,middle aged,epidemiology,epidemiology,survival analysis
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research (former - to 2023) Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit
Depositing User:	LivePure Connector
Date Deposited:	25 Feb 2019 15:30
Last Modified:	03 Nov 2022 15:47
URI:	https://ueaeprints.uea.ac.uk/id/eprint/70001
DOI:	10.1056/NEJMoa1808783

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