Hlatky, Mark A; Shilane, David; Boothroyd, Derek B; Boersma, Eric; Brooks, Maria M; Carrié, Didier; Clayton, Tim C; Danchin, Nicolas; Flather, Marcus; Hamm, Christian W; +8 more... Hueb, Whady A; Kahler, Jan; Lopes, Neuza; Pocock, Stuart J; Rodriguez, Alfredo; Serruys, Patrick; Sigwart, Ulrich; Stables, Rodney H; (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: https://doi.org/10.1016/j.jtcvs.2010.09.063
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Abstract
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.
Item Type | Article |
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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 |
ISI | 295255700015 |
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