Long-term Outcomes of Multiple Arterial Coronary Artery Bypass Grafting: A Population-Based Study of Patients in British Columbia, Canada

Autor: Jungwon Shin, Guy Fradet, Daniel R. Wong, John Bozinovski, Joel Price, James G. Abel, Lillian Ding, Peter Skarsgard, Aihua Pu
Rok vydání: 2017
Předmět:
Male
medicine.medical_treatment
Myocardial Infarction
Coronary Artery Disease
030204 cardiovascular system & hematology
Cohort Studies
Coronary artery bypass surgery
0302 clinical medicine
Interquartile range
Myocardial Revascularization
Medicine
Myocardial infarction
Longitudinal Studies
Coronary Artery Bypass
Original Investigation
education.field_of_study
Ejection fraction
Hazard ratio
Arteries
Middle Aged
surgical procedures
operative
Treatment Outcome
Radial Artery
Cardiology
Female
Cardiology and Cardiovascular Medicine
Vascular Surgical Procedures
medicine.medical_specialty
Population
Internal thoracic artery
Revascularization
03 medical and health sciences
medicine.artery
Internal medicine
Humans
Saphenous Vein
Mammary Arteries
Mortality
education
Propensity Score
Aged
Proportional Hazards Models
Retrospective Studies
Heart Failure
British Columbia
business.industry
medicine.disease
Surgery
030228 respiratory system
business
Zdroj: JAMA cardiology. 2(11)
ISSN: 2380-6591
Popis: Importance Although the long-term survival advantage of multiple arterial grafting (MAG) vs the standard use of left internal thoracic artery (LITA) supplemented by saphenous vein grafts (LITA+SVG) has been demonstrated in several observational studies, to our knowledge its safety and other long-term clinical benefits in a large, population-based cohort are unknown. Objective To compare the safety and long-term outcomes of MAG vs LITA+SVG among overall and selected subgroups of patients. Design, Setting, and Participants In this population-based observational study, we included 20 076 adult patients with triple-vessel or left-main disease who underwent primary isolated coronary artery bypass grafting (MAG, n = 5580; LITA+SVG, n = 14 496) in the province of British Columbia, Canada, from January 2000 to December 2014, with follow-up to December 2015. We performed propensity-score analyses by weighting and matching and multivariable Cox regression to minimize treatment selection bias. Exposures Multiple arterial grafting or LITA+SVG. Main Outcomes and Measures Mortality, repeated revascularization, myocardial infarction, heart failure, and stroke. Results Of 5580 participants who underwent MAG, 586 (11%) were women and the mean (SD) age was 60 (8.7) years. Of 14 496 participants who underwent LITA+SVG, 2803 (19%) were women and the mean (SD) age was 68 (8.9) years. The median (interquartile range) follow-up time was 9.1 (5.1-12.6) years and 8.1 (4.5-11.7) years for the groups receiving MAG and LITA+SVG, respectively. Compared with LITA+SVG, MAG was associated with reduced mortality rates (hazard ratio [HR], 0.79; 95% CI, 0.72-0.87) and repeated revascularization rates (HR, 0.74; 95% CI, 0.66-0.84) in 15-year follow-up and reduced incidences of myocardial infarction (HR, 0.63; 95% CI, 0.47-0.85) and heart failure (HR, 0.79; 95% CI, 0.64-0.98) in 7-year follow-up. The long-term benefits were coherent by all 3 statistical methods and persisted among patient subgroups with diabetes, obesity, moderately impaired ejection fraction, chronic obstructive pulmonary disease, peripheral vascular disease, or renal disease. Multiple arterial grafting was not associated with increased morbidity or mortality rates at 30 days overall or within patient subgroups. Conclusions and Relevance Compared with LITA+SVG, MAG is associated with reduced mortality, repeated revascularization, myocardial infarction, and heart failure among patients with multivessel disease who are undergoing coronary artery bypass grafting without increased mortality or other adverse events at 30 days. The long-term benefits consistently observed across multiple outcomes and subgroups support the consideration of MAG for a broader spectrum of patients who are undergoing coronary artery bypass grafting in routine practice.
Databáze: OpenAIRE
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