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Age cut-off for the loss of benefit from bilateral internal thoracic artery grafting
Siamak Mohammadi1, François Dagenais, Daniel Doyle
1Department of Cardiac surgery, Laval Hospital, 2725 chemin Ste-Foy, Québec city, QC, Canada, G1V 4G5.
Insights
Using at least one internal thoracic artery (ITA) graft improves long-term survival after coronary artery bypass grafting (CABG). Bilateral ITA grafting offers benefits up to age 60, while single ITA grafting benefits all ages.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Internal thoracic artery (ITA) grafting is a preferred method for coronary artery bypass grafting (CABG).
- The age-related benefits of single versus bilateral ITA grafting on long-term survival require further elucidation.
Purpose of the Study:
- To determine the age-specific survival advantage of single and bilateral internal thoracic artery (ITA) grafting compared to vein grafts in patients undergoing primary isolated coronary artery bypass grafting (CABG).
Main Methods:
- A unicenter study included 12,231 patients who underwent primary isolated CABG between 1992 and 2005, receiving single ITA (n=9566), bilateral ITA (n=1388), or vein grafts (n=1277).
- Prospective data collection and Cox regression analysis were used to assess cardiac-specific survival, with age as a covariate.
- Mean follow-up was 5.7 years, with 100% completeness as of December 2005.
Main Results:
- Bilateral ITA grafting provided superior cardiac-related survival compared to single ITA grafting in patients up to 60 years of age.
- Single ITA grafting demonstrated a survival benefit across all age groups, including octogenarians, when compared to vein grafts only.
- The survival advantage of bilateral ITA grafting diminished with increasing age, becoming negligible after 60 years.
Conclusions:
- The utilization of at least one internal thoracic artery (ITA) graft is associated with enhanced long-term cardiac-specific survival in all age categories compared to vein-only grafts.
- The incremental survival benefit of employing a second ITA graft diminishes progressively with age and is not observed in patients over 60 years old.
Objectives:
To identify the age-related benefit of single and bilateral internal thoracic artery (ITA) grafting on long-term cardiac-related survival in patients who survived from primary isolated coronary artery bypass grafting (CABG).
Methods:
A unicenter study was conducted on 12,231 consecutive survivors from primary isolated CABG who received single (n=9566 patients) or bilateral (n=1388 patients) ITA grafts, or vein grafts only (n=1277 patients) between 1992 and 2005. Data was collected prospectively. The Cox regression model estimates the hazard ratio of each independent variable on cardiac-specific survival over the entire length of follow-up. Age was a significant covariate into the statistical model. The mean follow-up was 5.7+/-3.7 years and 100% complete as of December 2005. The date and cause of death were obtained from the regional statistical institute.
Results:
After adjustments for different risk factors, the cardiac-related survival benefit in patients undergoing CABG with two ITAs was superior to that of single ITA grafting up to 60 years of age, displaying a constant decrease over time. The use of a single ITA was beneficial on cardiac-related survival in all age groups, including octogenarians, compared to patients receiving only vein grafts.
Conclusions:
The use of at least one ITA is associated with increased long-term cardiac-specific survival in all age groups compared to venous-only CABG, even in octogenarians. The additional survival benefit of using a second ITA decreases gradually with age, and is lost after 60 years of age.
