David P Taggart1, Mario F Gaudino2, Stephen Gerry3, Alastair Gray4, Belinda Lees1, Arnaldo Dimagli5, John D Puskas6, Vipin Zamvar7, Rafał Pawlaczyk8, Alistair G Royse9, Marcus Flather10, Umberto Benedetto5. 1. Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom. 2. Cardiothoracic Surgery at Weill Cornell Medical Center, New York, NY. Electronic address: mfg9004@med.cornell.edu. 3. Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom. 4. Department of Public Health, Health Economics Research Centre, University of Oxford, Oxford, United Kingdom. 5. School of Clinical Sciences, Bristol Heart Institute, University of Bristol, United Kingdom. 6. Cardiothoracic Surgery at The Mount Sinai Hospital, New York, NY. 7. Department of Cardio-Thoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. 8. Medical University of Gdansk, Gdańsk, Poland. 9. Royal Melbourne Hospital, University of Melbourne, Australia. 10. Research and Development Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom.
Abstract
OBJECTIVES: The Arterial Revascularization Trial (ART) was designed to compare 10-year survival in bilateral versus single internal thoracic artery grafts. The intention-to-treat analysis has showed comparable outcomes between the 2 groups but an explanatory analysis suggested that those receiving 2 or more arterial grafts had better survival. Whether the exclusive use of arterial grafts provide further benefit is unclear. METHODS: We performed an exploratory analysis of the ART based on conduits actually received (as-treated principle). From ART cohort, only patients receiving at least 3 grafts were included. The final population consisted of 1084, 1010, and 390 patients in the single arterial graft (SAG) group, in the multiple arterial graft (MAG) group (2 or more arterial grafts with additional saphenous veins) and total arterial graft (TAG) group (3 or more arterial grafts only) respectively. Inverse probability of treatment weighting was used for comparison. RESULTS: When compared with the SAG group, there was a significant trend toward a reduction of 10-year mortality in the MAG and TAG group (test for trend P = .02). The TAG group was associated with the lowest risk of late mortality (hazard ratio, 0.68; 95% confidence interval, 0.48-0.96; P = .03) and with a significant risk reduction of the composite of death/myocardial infarction/stroke and repeat revascularization (hazard ratio, 0.71; 95% confidence interval, 0.53-0.94; P = .02). CONCLUSIONS: When compared with SAG, both MAG and TAG represent valuable strategies to improve clinical outcomes following coronary artery bypass grafting but TAG can potentially provide further benefit.
OBJECTIVES: The Arterial Revascularization Trial (ART) was designed to compare 10-year survival in bilateral versus single internal thoracic artery grafts. The intention-to-treat analysis has showed comparable outcomes between the 2 groups but an explanatory analysis suggested that those receiving 2 or more arterial grafts had better survival. Whether the exclusive use of arterial grafts provide further benefit is unclear. METHODS: We performed an exploratory analysis of the ART based on conduits actually received (as-treated principle). From ART cohort, only patients receiving at least 3 grafts were included. The final population consisted of 1084, 1010, and 390 patients in the single arterial graft (SAG) group, in the multiple arterial graft (MAG) group (2 or more arterial grafts with additional saphenous veins) and total arterial graft (TAG) group (3 or more arterial grafts only) respectively. Inverse probability of treatment weighting was used for comparison. RESULTS: When compared with the SAG group, there was a significant trend toward a reduction of 10-year mortality in the MAG and TAG group (test for trend P = .02). The TAG group was associated with the lowest risk of late mortality (hazard ratio, 0.68; 95% confidence interval, 0.48-0.96; P = .03) and with a significant risk reduction of the composite of death/myocardial infarction/stroke and repeat revascularization (hazard ratio, 0.71; 95% confidence interval, 0.53-0.94; P = .02). CONCLUSIONS: When compared with SAG, both MAG and TAG represent valuable strategies to improve clinical outcomes following coronary artery bypass grafting but TAG can potentially provide further 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