Francesco Formica1, Stefano D'Alessandro2, Gurmeet Singh3, Ana Maria Ciobanu4, Luigi Amerigo Messina5, Salvatore Scianna2, Mario Moscatiello2. 1. Cardiac Surgery Unit, ASST San Gerardo Hospital, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. Electronic address: francesco_formica@fastwebnet.it. 2. Cardiac Surgery Unit, ASST San Gerardo Hospital, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. 3. Division of Cardiac Surgery, Department of Critical Care Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. 4. Emergency Department, IRCCS Humanitas Hospital, Milan, Italy. 5. Statistics and Quality Health Service, ASST San Gerardo Hospital, Monza, Italy.
Abstract
BACKGROUND: Long-term survival benefits of full arterial revascularization with radial artery (RA) used in addition to bilateral internal mammary arteries (BIMA) compared with saphenous vein (SV) used in addition to BIMA has not been clearly defined. METHODS: We retrospectively analyzed 660 3-vessel coronary artery disease subjects who received BIMA in addition to either RA (n = 206) or SV (n = 454) grafting in a period between June 1999 and November 2017. After propensity score matching, we obtained 190 matched pairs for analysis. RESULTS: In the matched population, in-hospital mortality occurred in 4 patients (1%), with 2 deaths (1.1%) in the BIMA + RA group and 2 deaths (1.1%) in BIMA + SV group (P > .99). The median follow-up time was 9.2 years (interquartile range, 5.6-13 years) with a maximum follow-up time of 18.5 years. There was not a significant difference in long-term survival between the 2 groups over the follow-up period. Survival at 5, 10, and 15 years were 94.8 ± 1.7%, 83.7 ± 3.1%, and 78.6 ± 3.9% in the BIMA + RA group and 96.2 ± 1.4%, 85.1 ± 2.9%, and 80.4 ± 3.6% in the BIMA + SV group (stratified log-rank P = .78). Cox proportional hazard regression model was used to estimate that the use of RA in addition to BIMA did not affect the late mortality (propensity score adjusted hazard ratio, 1.05; 95% confidence interval, 0.62-1.79; P = .83). CONCLUSIONS: In a relatively small population of triple-vessel coronary artery disease, the use of RA as a third arterial conduit with BIMA did not confer a long-term survival benefit.
BACKGROUND: Long-term survival benefits of full arterial revascularization with radial artery (RA) used in addition to bilateral internal mammary arteries (BIMA) compared with saphenous vein (SV) used in addition to BIMA has not been clearly defined. METHODS: We retrospectively analyzed 660 3-vessel coronary artery disease subjects who received BIMA in addition to either RA (n = 206) or SV (n = 454) grafting in a period between June 1999 and November 2017. After propensity score matching, we obtained 190 matched pairs for analysis. RESULTS: In the matched population, in-hospital mortality occurred in 4 patients (1%), with 2 deaths (1.1%) in the BIMA + RA group and 2 deaths (1.1%) in BIMA + SV group (P > .99). The median follow-up time was 9.2 years (interquartile range, 5.6-13 years) with a maximum follow-up time of 18.5 years. There was not a significant difference in long-term survival between the 2 groups over the follow-up period. Survival at 5, 10, and 15 years were 94.8 ± 1.7%, 83.7 ± 3.1%, and 78.6 ± 3.9% in the BIMA + RA group and 96.2 ± 1.4%, 85.1 ± 2.9%, and 80.4 ± 3.6% in the BIMA + SV group (stratified log-rank P = .78). Cox proportional hazard regression model was used to estimate that the use of RA in addition to BIMA did not affect the late mortality (propensity score adjusted hazard ratio, 1.05; 95% confidence interval, 0.62-1.79; P = .83). CONCLUSIONS: In a relatively small population of triple-vessel coronary artery disease, the use of RA as a third arterial conduit with BIMA did not confer a long-term survival benefit.
Authors: Sérgio C Rayol; Jef Van den Eynde; Luiz Rafael P Cavalcanti; Antonio Carlos Escorel; Arian Arjomandi Rad; Andrea Amabile; Wilson Botelho; Arjang Ruhparwar; Konstantin Zhigalov; Alexander Weymann; Dario Celestino Sobral; Michel Pompeu B O Sá Journal: Braz J Cardiovasc Surg Date: 2021-02-01