Propensity-score analysis of early outcomes after bilateral versus single internal thoracic artery grafting.

Autor:	Pusca SV; From the *Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine; and †Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia., Kilgo PD, Vega JD, Cooper WA, Vassiliades TA, Chen EP, Lattouf OM, Guyton RA, Puskas JD
Jazyk:	angličtina
Zdroj:	Innovations (Philadelphia, Pa.) [Innovations (Phila)] 2008 Jan; Vol. 3 (1), pp. 19-24.
DOI:	10.1097/IMI.0b013e31817067fb
Abstrakt:	Objective: : The use of bilateral internal thoracic arteries (BITAs) during coronary artery bypass grafting (CABG) improves long-term and event-free survival compared with single internal thoracic artery (SITA) grafting. It is controversial whether BITA grafting alters in-hospital adverse events after CABG. Methods: : Isolated CABG cases using BITA or SITA at a single US academic center between January 1, 1997 and June 30, 2006 were retrospectively reviewed. A propensity score was used as a covariate to balance the treatment groups (BITA and SITA) with respect to 44 preoperative risk factors. A multivariable logistic regression model tested whether treatment type was significantly associated with in-hospital death, deep sternal wound infection (DSWI), or hospital length of stay (LOS). Results: : There were 599 BITA and 10,212 SITA cases performed. Overall for all BITA versus SITA cases, adjusted mortality (0.8% vs. 1.7%, P = 0.85) was not different between the groups. However, adjusted incidence of DSWI (2.0% vs. 1.2%, P = 0.036) and LOS (6.7 vs. 6.1, P = 0.025) were significantly higher in BITA patients. Subsets analyses of obese patients and diabetic patients revealed no statistical differences for any of the outcomes between BITA and SITA. Conclusions: : The long-term benefits of BITA grafting do not come at the cost of increased adjusted risk of in-hospital death. BITA grafting was associated with an increased risk of DSWI and a longer adjusted LOS. Neither obesity, nor diabetes significantly increased the risk of poor outcomes after BITA.
Databáze:	MEDLINE
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