Acquired cardiovascular disease
Is the second internal thoracic artery better than the radial artery in total arterial off-pump coronary artery bypass grafting? A propensity score–matched follow-up study

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Objective

The aim of our study was to evaluate the long-term outcome of patients exclusively undergoing total arterial revascularization off-pump coronary artery bypass grafting and to compare the performance of the radial artery and the right internal thoracic artery as a second conduit.

Methods

We studied a consecutive series of 1700 patients undergoing off-pump coronary artery bypass grafting, receiving a radial artery or right internal thoracic artery as a second graft for total arterial revascularization, between 2003 and 2010. A total of 1447 patients (85.11%) received bilateral internal thoracic artery grafting, and 253 patients (14.89%) received left internal thoracic artery and radial artery grafting. A propensity score–matched analysis was performed to compare the 2 groups, bilateral internal thoracic artery and left internal thoracic artery and radial artery, relative to overall survival, morbidity, and combined end points event–free survival. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were estimated by Cox regression.

Results

In the full unmatched patient population, the postoperative survival (HR, 0.59; 95% CI, 0.38-0.92; P = .021), incidence of reintervention/readmission (HR, 0.42; 95% CI, 0.28-0.61; P < .001), and combined end points (HR, 0.47; 95% CI, 0.35-0.63; P < .001) were significantly better in the bilateral internal thoracic artery group. In the propensity score–matched patient population, the incidence of reintervention/readmission (HR, 0.40; 95% CI, 0.18-0.88; P = .02) and combined end points (HR, 0.54; 95% CI, 0.32-0.92; P = .02) were significantly better in the bilateral internal thoracic artery group compared with the left internal thoracic artery–radial artery group.

Conclusions

The results of our study provide evidence for the superiority of the right internal thoracic artery graft compared with the radial artery as a second conduit in total arterial revascularization off-pump coronary artery bypass grafting.

Abbreviations and Acronyms

BITA
bilateral internal thoracic artery
CABG
coronary artery bypass grafting
CI
confidence interval
euroSCORE
European System for Cardiac Operative Risk Evaluation
HR
hazard ratio
IQR
interquartile range
ITA
internal thoracic artery
LAD
left anterior descending
LITA
left internal thoracic artery
OPCAB
off-pump coronary artery bypass
OR
odds ratio
RA
radial artery
RITA
right internal thoracic artery
SVG
saphenous vein graft
TAR
total arterial revascularization

CTSNet classification

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Disclosures: Authors have nothing to disclose with regard to commercial support.