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Statin treatment equalizes long-term survival between patients with single and bilateral internal thoracic artery
Michel Carrier1, Mariève Cossette, Michel Pellerin
1Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada. michel.carrier@icmmhi.org
Insights
Bilateral internal thoracic artery (ITA) grafts improve survival after coronary artery bypass grafting (CABG). Statin use enhances long-term survival for single ITA grafts, but not for bilateral ITA grafts.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
Background:
- Bilateral internal thoracic artery (ITA) grafting significantly increases 10-year survival post-coronary artery bypass grafting (CABG) compared to single ITA grafts.
- Statin therapy is known to reduce atherosclerosis in saphenous vein grafts.
Purpose of the Study:
- To investigate the impact of statin treatment on long-term survival following CABG.
Main Methods:
- Analysis of operative, survival, and pharmacologic data from 6,655 patients undergoing CABG with ITAs between 1995 and 2007.
- Comparison of survival rates between patients receiving single versus bilateral ITA grafts.
- Assessment of statin treatment's effect on long-term mortality risk in both graft groups.
Main Results:
- Patients with bilateral ITA grafts demonstrated an 83% 10-year survival rate versus 67% for single ITA grafts (p=0.0001).
- Statin treatment significantly decreased long-term death risk in single ITA graft patients (HR, 0.735; p=0.0001).
- Statin treatment showed no significant effect on long-term death risk in bilateral ITA graft patients (HR, 1.053; p=0.7806).
Conclusions:
- Early statin initiation post-CABG improves long-term survival for patients with single ITA grafts.
- Statin therapy does not impact long-term survival in patients with bilateral ITA grafts.
- Long-term survival in statin-treated single ITA graft patients is comparable to that of bilateral ITA graft patients.
Background:
The use of 2 internal thoracic artery (ITA) grafts increases survival 10 years after coronary artery bypass grafting (CABG) compared with single ITA grafting. Statin treatment was also shown to decrease development and progression of saphenous vein graft atherosclerosis. This study examined the effect of statin treatment on long-term survival after CABG.
Methods:
Operative, survival, and pharmacologic data of 6655 patients who underwent CABG with ITAs between 1995 and 2007 in our institution were obtained.
Results:
Patients with bilateral ITA grafts had an average 10-year-survival rate of 83% +/- 2% compared with 67% +/-1% in patients with single ITA grafts (p = 0.0001). Statin treatment caused a significant decrease in the long-term risk of death among patients who underwent single ITA grafting (hazard ratio [HR], 0.735, p = 0.0001). However, statin treatment had no effect on the risk of long-term death among patients who underwent bilateral ITA grafting (HR, 1.053; p = 0.7806).
Conclusions:
Statin treatment initiated early after grafting improved long-term survival in patients with a single ITA graft but not in those with bilateral ITA grafts. Survival of statin-treated patients with single ITA grafts was similar to bilateral ITA patients.