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; Flather, Marcus

doi:10.1056/NEJMoa1808783

Title

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

Publication Date

2019-01-31

Author(s)

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

Type of document

Journal Article

OrcId

#PLACEHOLDER_PARENT_METADATA_VALUE#

DOI

10.1056/NEJMoa1808783

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 .).

Link

link

Citation

The New England Journal of Medicine 2019; 380(5): 437-446

Jornal Title

The New England Journal of Medicine

Austin Health

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