Gaudino, Mario, Audisio, Katia, Rahouma, Mohamed, Chadow, David, Cancelli, Gianmarco, Soletti, Giovanni J., Gray, Alastair, Lees, Belinda, Gerry, Stephen, Benedetto, Umberto, Flather, Marcus and Taggart, David P. and ART Investigators (2021) Comparison of long-term clinical outcomes of skeletonized vs pedicled internal thoracic artery harvesting techniques in the arterial revascularization trial. JAMA Cardiology, 6 (12). pp. 1380-1386. ISSN 2380-6583
Full text not available from this repository. (Request a copy)Abstract
Importance: Recent evidence has suggested that skeletonization of the internal thoracic artery (ITA) is associated with worse clinical outcomes in patients undergoing coronary artery bypass surgery (CABG). Objective: To compare the long-term clinical outcomes of skeletonized and pedicled ITA for CABG. Design, Setting, and Participants: The Arterial Revascularization Trial (ART) was a 2-group, multicenter trial comparing the use of a bilateral ITA vs a single ITA for CABG at 10 years. Patients in the ART trial were stratified by ITA harvesting technique: skeletonized vs pedicled. Data were collected from June 2004 to December 2017, and data were analyzed from June to July 2021. Interventions: In this analysis, the 10-year clinical outcomes were compared between patients who received skeletonized vs pedicled ITAs. Main Outcomes and Measures: The primary outcome was all-cause mortality. The secondary outcomes were a composite of major adverse cardiac events (MACE) including all-cause mortality, myocardial infarction, and repeated revascularization and a composite including MACE and sternal wound complication (SWC). Cox regression and propensity score matching were used. Results: Of 2161 included patients, 295 (13.7%) were female, and the median (interquartile range) age was 65.0 (58.0-70.0) years. At 10 years, the risk of all-cause mortality was not significantly different between the pedicled and skeletonized groups (hazard ratio [HR], 1.12; 95% CI, 0.92-1.36; P =.27). However, the long-term risks of the secondary outcomes were significantly higher in the skeletonized group compared with the pedicled group (MACE: HR, 1.25; 95% CI, 1.06-1.47; P =.01; MACE and SWC: HR, 1.22; 95% CI, 1.05-1.43; P =.01). The difference was not seen when considering only patients operated on by surgeons who enrolled 51 patients or more in the trial (MACE: HR, 1.07; 95% CI, 0.82-1.39; P =.62; MACE and SWC: HR, 1.04; 95% CI, 0.80-1.34; P =.78). Conclusions and Relevance: While the long-term survival of patients was not different between groups, the rate of adverse cardiovascular events was consistently higher in the skeletonized group and the difference was associated with surgeon-related factors. Further evidence on the outcome of skeletonized ITA is needed.
Item Type: | Article |
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Uncontrolled Keywords: | cardiology and cardiovascular medicine ,/dk/atira/pure/subjectarea/asjc/2700/2705 |
Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
Related URLs: | |
Depositing User: | LivePure Connector |
Date Deposited: | 22 Dec 2021 09:30 |
Last Modified: | 03 Nov 2022 16:34 |
URI: | https://ueaeprints.uea.ac.uk/id/eprint/82788 |
DOI: | 10.1001/jamacardio.2021.3866 |
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