Multiarterial coronary grafting using the radial artery as a second arterial graft: how far does the survival benefit extend?
| Autor: | Selvaraj Shanmuganathan, Surendra K. Naik, Anas Boulemden, Saqib H Qureshi, Adam Szafranek, Oliver Darwin |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty medicine.medical_treatment Population Coronary Artery Disease Anastomosis Revascularization Angina Internal medicine medicine.artery medicine Humans Mammary Arteries Radial artery Propensity Score education Aged Retrospective Studies education.field_of_study business.industry Hazard ratio General Medicine Middle Aged medicine.disease Confidence interval Treatment Outcome medicine.anatomical_structure Radial Artery Cardiology Surgery Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. 61:216-224 |
| ISSN: | 1873-734X 1010-7940 |
| DOI: | 10.1093/ejcts/ezab308 |
| Popis: | OBJECTIVES Despite the 10-year results of the Arterial Revascularization Trial, the controversy regarding the survival benefit of multiarterial grafting (MAG) remains. Our goal was to present our long-term survival data in this propensity-matched observational study. METHODS A primary unmatched population of 4303 patients with first-time isolated coronary artery bypass grafts operated on between 2000 and 2018 were included. A total of 1187 post-matched patients were compared with matched controls. Multivariate logistic regression and Cox proportional hazard analyses were undertaken to assess the contribution of MAG and other covariates to the long-term survival of unmatched and propensity-matched populations. RESULTS MAG was associated with increased median survival in both the unmatched and the matched groups; difference: 962 and 1459 days, log-rank tests; P = 0.029 and 0.0004, respectively. MAG was associated with a reduced hazard of death in the unmatched as well as in the matched groups: hazard ratio [95% confidence interval (CI)]: 0.72 (0.62–0.83); P 30%, age 50–69 years, operation by an experienced surgeon, with and without diabetes, on-pump surgery and 3 distal anastomoses. In a cohort of 242 late-presenting patients with reinfarction or recurrent angina, both MAG and control populations were associated with reduced median survival; median (95% CI): MAG: 3026 (1138–3503); control: 3035 (2134–3991), log-rank P = 0.217 with superior patency of the left internal mammary artery but no difference between radial artery and saphenous vein grafts. CONCLUSIONS Multiarterial revascularization, especially using the radial artery as a second arterial conduit, is associated with a significant survival benefit and a lack of in-hospital morbidity. |
| Databáze: | OpenAIRE |
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