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Updated: May 8, 2026
Human Internal Mammary Artery (IMA) Transplantation and Stenting: A Human Model to Study the Development of In-Stent Restenosis
Published on: May 9, 2012
A meta-analysis comparing bilateral internal mammary artery with left internal mammary artery for coronary artery
Aaron J Weiss1, Shan Zhao, David H Tian
1Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York City, New York, USA; ; The Collaborative Research (CORE) Group, Sydney, Australia;
Insights
Bilateral internal mammary artery (BIMA) grafting offers improved long-term survival compared to left internal mammary artery (LIMA) in coronary artery bypass grafting (CABG) surgery. This meta-analysis confirms BIMA as a superior primary grafting strategy for CABG patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Research
Background:
- Growing evidence suggests bilateral internal mammary artery (BIMA) offers survival benefits over left internal mammary artery (LIMA) in coronary artery bypass grafting (CABG).
- Previous studies indicate a potential advantage for BIMA in CABG procedures.
Purpose of the Study:
- To conduct an updated meta-analysis comparing BIMA versus LIMA in CABG.
- To assess differences in long-term survival rates between BIMA and LIMA grafting strategies.
Main Methods:
- Systematic electronic searches of three databases from 1972 to December 2012.
- Inclusion criteria: studies with ≥4 years follow-up and ≥100 patients per group.
- Random-effect model used to pool hazard ratios from 27 observational studies.
Main Results:
- Analysis included 79,063 patients (19,277 BIMA, 59,786 LIMA).
- Bilateral internal mammary artery (BIMA) demonstrated significantly better long-term survival than left internal mammary artery (LIMA) [HR, 0.78; 95% CI, 0.72-0.84; P<0.00001].
Conclusions:
- Updated meta-analysis shows increased long-term survival with BIMA over LIMA in CABG.
- The survival benefit of BIMA warrants consideration in CABG surgical decisions.
- BIMA is the preferred grafting strategy based on current evidence pending ART trial results.
Background:
Increasing evidence continues to demonstrate a survival advantage for bilateral internal mammary artery (BIMA) over left internal mammary artery (LIMA) for coronary artery bypass grafting (CABG). We performed an updated meta-analysis of published studies comparing BIMA versus LIMA in CABG operations and assessed differences in long-term survival.
Methods:
Electronic searches for studies comparing BIMA versus LIMA were performed using three databases from 1972 to December 2012. Studies with at least four years of follow-up and at least 100 patients in each group were included for review. We used a random-effect model and pooled hazard ratios from across all included studies.
Results:
No randomized controlled trials and 27 observational studies totaling 79,063 patients (19,277 BIMA, 59,786 LIMA) were included for final analysis. The BIMA group demonstrated significantly better long-term survival than the LIMA group [hazard ratio, 0.78; confidence interval, 0.72-0.84; P<0.00001].
Conclusions:
In an updated meta-analysis, we demonstrate an increase in long-term survival in patients receiving BIMA as a primary grafting strategy over those receiving a LIMA. Although no randomized controlled trials were included in this meta-analysis, the survival benefit seen with a BIMA cannot be overlooked when determining which operation to perform in CABG patients. Until the long-term results of the ART trial are published, we offer best available evidence in favor of BIMA over LIMA for CABG surgery.
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