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Propensity-score analysis of early outcomes after bilateral versus single internal thoracic artery grafting
Sorin V Pusca1, Patrick D Kilgo, J David Vega
1From the *Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine; and †Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Insights
Bilateral internal thoracic artery (BITA) grafting in coronary artery bypass grafting (CABG) does not increase in-hospital death risk. However, BITA is linked to higher deep sternal wound infection and longer hospital stays, with no increased risk for obese or diabetic patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Research
Background:
- Bilateral internal thoracic artery (BITA) grafting improves long-term survival in coronary artery bypass grafting (CABG).
- The impact of BITA on in-hospital adverse events post-CABG remains controversial.
Purpose of the Study:
- To evaluate the association between BITA grafting and in-hospital adverse events after CABG.
- To compare in-hospital mortality, deep sternal wound infection (DSWI), and length of stay (LOS) between BITA and single internal thoracic artery (SITA) groups.
Main Methods:
- Retrospective review of isolated CABG cases (1997-2006) at a single US academic center.
- Propensity score matching to balance 44 preoperative risk factors between BITA and SITA groups.
- Multivariable logistic regression analysis to assess the impact of treatment type on outcomes.
Main Results:
- No significant difference in adjusted in-hospital mortality between BITA (0.8%) and SITA (1.7%) groups (P = 0.85).
- BITA grafting was associated with a significantly higher adjusted incidence of DSWI (2.0% vs. 1.2%, P = 0.036) and longer adjusted LOS (6.7 vs. 6.1 days, P = 0.025).
- Subset analyses showed no increased risk for obese or diabetic patients undergoing BITA grafting.
Conclusions:
- Long-term benefits of BITA grafting do not increase in-hospital death risk.
- BITA grafting is associated with increased risks of DSWI and longer LOS.
- Obesity and diabetes do not significantly increase the risk of adverse outcomes with BITA grafting.
Objective:
: The use of bilateral internal thoracic arteries (BITAs) during coronary artery bypass grafting (CABG) improves long-term and event-free survival compared with single internal thoracic artery (SITA) grafting. It is controversial whether BITA grafting alters in-hospital adverse events after CABG.
Methods:
: Isolated CABG cases using BITA or SITA at a single US academic center between January 1, 1997 and June 30, 2006 were retrospectively reviewed. A propensity score was used as a covariate to balance the treatment groups (BITA and SITA) with respect to 44 preoperative risk factors. A multivariable logistic regression model tested whether treatment type was significantly associated with in-hospital death, deep sternal wound infection (DSWI), or hospital length of stay (LOS).
Results:
: There were 599 BITA and 10,212 SITA cases performed. Overall for all BITA versus SITA cases, adjusted mortality (0.8% vs. 1.7%, P = 0.85) was not different between the groups. However, adjusted incidence of DSWI (2.0% vs. 1.2%, P = 0.036) and LOS (6.7 vs. 6.1, P = 0.025) were significantly higher in BITA patients. Subsets analyses of obese patients and diabetic patients revealed no statistical differences for any of the outcomes between BITA and SITA.
Conclusions:
: The long-term benefits of BITA grafting do not come at the cost of increased adjusted risk of in-hospital death. BITA grafting was associated with an increased risk of DSWI and a longer adjusted LOS. Neither obesity, nor diabetes significantly increased the risk of poor outcomes after BITA.
