Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/20236
Title: Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years.
Authors: 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;Flather, Marcus
Affiliation: Nuffield Department of Surgical Sciences, John Radcliffe Hospital, United Kingdom
Department of Cardiac Surgery, Royal Infirmary, Manchester, United Kingdom
Royal Brompton Hospital and Imperial College London, London, United Kingdom
Department of Cardiac Surgery, King's College Hospital, London, United Kingdom
Department of Cardiac Surgery, Freeman Hospital, Newcastle, United Kingdom
Royal Papworth Hospital, Cambridge, United Kingdom
School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol, United Kingdom
Department of Cardiac Surgery, University Hospital of Wales, Cardiff, United Kingdom
Department of Cardiac Surgery, Royal Sussex County, Brighton, United Kingdom
Norwich Medical School, University of East Anglia, United Kingdom
Norfolk and Norwich University Hospital, Norwich, United Kingdom
Heart Institute of Pernambuco, Recife, Brazil
Centre for Statistics in Medicine, Botnar Research Centre, Oxford, United Kingdom
Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw, Poland
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
Mount Sinai St. Luke's, New York, NY, USA
Center for Cardiovascular Research and Development, American Heart of Poland, Poland
Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
Department of Cardiac Surgery, Austin Health, Heidelberg, Victoria, Australia
Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
Issue Date: 31-Jan-2019
Citation: The New England journal of medicine 2019; 380(5): 437-446
Abstract: 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. 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. 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). 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. (Funded by the British Heath Foundation and others; Current Controlled Trials number, ISRCTN46552265 .).
URI: http://ahro.austin.org.au/austinjspui/handle/1/20236
DOI: 10.1056/NEJMoa1808783
PubMed URL: 30699314
Type: Journal Article
Appears in Collections:Journal articles

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