Faculty Collaboration Database

Multiple arterial grafts improve survival with coronary artery bypass graft surgery versus conventional coronary artery bypass grafting compared with percutaneous coronary interventions. J Thorac Cardiovasc Surg 2016 Aug;152(2):369-379.e4

Date

05/14/2016

Pubmed ID

27174511

DOI

10.1016/j.jtcvs.2016.03.089

Scopus ID

2-s2.0-84975121920 (requires institutional sign-in at Scopus site)   34 Citations

Abstract

OBJECTIVE: To compare long-term survival with multiple arterial coronary artery bypass grafting (CABG) (MultArt) versus percutaneous coronary intervention (PCI) in patients with multivessel disease (MVD).

METHODS: We reviewed 12,615 patients with MVD with isolated primary CABG or PCI from 1993 to 2009. Patients with CABG (n = 6667) were grouped according to the number of arterial grafts into left internal thoracic artery (LITA)/saphenous vein (SV) (n = 5712) or MultArt (n = 955); patients with PCI (n = 5948) were grouped into balloon angioplasty (BA) (n = 1020), drug-eluting stent (DES) (n = 1686), and bare metal stent (BMS) (n = 3242).

RESULTS: Unadjusted long-term survival was lower for CABG than PCI (15-year survival, 34% vs 46%; P < .001); however, in patients with MultArt, survival was greater than LITA/SV, BA, BMS (15-year survival, 65% vs 31%, 47%, 45%, respectively; P < .001), and DES (8-year survival, 87% vs 70%; P < .001). In matched analyses, 15-year survival of MultArt was higher than BA (66% vs 57%; P = .002), LITA/SV (64% vs 56%; P = .02), and BMS (5-year survival 94% vs 90%; P = .01), and similar to DES at 8 years. In multivariate analysis, compared with MultArt, LITA/SV had worse survival (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.09-1.52; P = .003). BMS (HR, 0.87; 95% CI, 0.80-0.94; P < .001) and DES (HR, 0.76; 95% CI, 0.66-0.88; P < .001) had improved survival versus LITA/SV but not versus MultArt (HR, 1.12; 95% CI, 0.94-1.34; P = .21, and HR, 0.98; 95% CI, 0.79-1.21; P = .83, respectively). Secondary analyses for treatment crossover indicated lower survival for LITA/SV versus MultArt and PCI.

CONCLUSIONS: In patients with MVD undergoing primary revascularization, MultArt increased survival benefit versus LITA/SV compared with PCI. Use of MultArt must increase.

Author List

Locker C, Schaff HV, Daly RC, Dearani JA, Bell MR, Frye RL, Greason KL, Stulak JM, Joyce LD, Pochettino A, Li Z, Lennon RJ, Lerman A

MESH terms used to index this publication - Major topics in bold

Aged
Angioplasty, Balloon, Coronary
Chi-Square Distribution
Coronary Artery Bypass
Coronary Artery Disease
Drug-Eluting Stents
Female
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Metals
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Prosthesis Design
Retrospective Studies
Risk Factors
Stents
Time Factors
Treatment Outcome