The effect of internal thoracic artery grafts on long-term clinical outcomes after coronary bypass surgery

Hlatky, MA; Shilane, D; Boothroyd, DB; Boersma, E; Brooks, MM; Carrie, D; Clayton, TC; Danchin, N; Flather, M; Hamm, CW; Hueb, WA; Kahler, J; Lopes, N; Pocock, SJ; Rodriguez, A; Serruys, P; Sigwart, U; Stables, RH; (2011) The effect of internal thoracic artery grafts on long-term clinical outcomes after coronary bypass surgery. The Journal of thoracic and cardiovascular surgery, 142 (4). pp. 829-835. ISSN 0022-5223 DOI:

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Objectives: We sought to compare long-term outcomes after coronary bypass surgery with and without an internal thoracic artery graft. Methods: We analyzed clinical outcomes over a median follow-up of 6.7 years among 3,087 patients who received coronary bypass surgery as participants in one of 8 clinical trials comparing surgical intervention with angioplasty. We used 2 statistical methods (covariate adjustment and propensity score matching) to adjust for the nonrandomized selection of internal thoracic artery grafts. Results: Internal thoracic artery grafting was associated with lower mortality, with hazard ratios of 0.77 (confidence interval, 0.62-0.97; P = .02) for covariate adjustment and 0.77 (confidence interval, 0.57-1.05; P = .10) for propensity score matching. The composite end point of death or myocardial infarction was reduced to a similar extent, with hazard ratios of 0.83 (confidence interval, 0.69-1.00; P = .05) for covariate adjustment to 0.78 (confidence interval, 0.61-1.00; P = .05) for propensity score matching. There was a trend toward less angina at 1 year, with odds ratios of 0.81 (confidence interval, 0.61-1.09; P = .16) in the covariate-adjusted model and 0.81 (confidence interval, 0.55-1.19; P = .28) in the propensity score-adjusted model. Conclusions: Use of an internal thoracic artery graft during coronary bypass surgery seems to improve long-term clinical outcomes. (J Thorac Cardiovasc Surg 2011; 142: 829-35)

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Medical Statistics
Research Centre: Centre for Global Non-Communicable Diseases (NCDs)
PubMed ID: 21334008
Web of Science ID: 295255700015


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