Second Internal Thoracic Artery Versus Radial Artery in Coronary Artery Bypass Grafting: A Long-Term, Propensity Score―Matched Follow-Up Study

• Published in: Circulation (New York, N.Y.) N.Y.), 2011-09, Vol.124 (12), p.1321-1329
• Main Authors: RUTTMANN, Elfriede, FISCHLER, Nikolaus, SAKIC, Adel, CHEVTCHIK, Orest, ALBER, Hannes, SCHISTEK, Roland, ULMER, Hanno, GRIMM, Michael
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - methods; Coronary Artery Bypass - mortality; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Evidence-Based Medicine; Female; Follow-Up Studies; Humans; Male; Mammary Arteries - transplantation; Medical sciences; Middle Aged; Myocardial Revascularization - adverse effects; Myocardial Revascularization - methods; Myocardial Revascularization - mortality; Postoperative Complications - mortality; Propensity Score; Prospective Studies; Radial Artery - transplantation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.111.030536

The best second arterial conduit for multiple arterial revascularization (MAR) is still a matter of debate. Previous studies on the benefit of either using the radial artery (RA) or the right internal thoracic artery (RITA) in coronary artery bypass grafting are not conclusive. The aim of our study was to compare the perioperative and long-term outcome of either RA or RITA grafts as second conduits for MAR. A consecutive series of 1001 patients undergoing first nonemergent coronary artery bypass grafting receiving either RA or RITA as second graft for MAR between 2001 and 2010 were studied. There were 277 patients receiving a RITA and 724 patients receiving a RA in addition to a left internal thoracic artery (LITA). Concomitant saphenous vein grafts (SVG) were grafted in addition as necessary. Propensity score-matched analysis was performed to compare the 2 groups, bilateral ITA±SVG (BITA±SVG group) and the LITA+RA±SVG group relative to overall survival and major adverse cardiac and cerebrovascular events-free survival. Hazard ratios and their 95% confidence intervals were estimated by COX regression stratified on matched pairs. The incidence of perioperative major adverse cardiac and cerebrovascular events was significantly lower in the BITA±SVG group (1.4% versus 7.6%, P