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

被引：347

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

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