Association of Age With 10-Year Outcomes After Coronary Surgery in the Arterial Revascularization Trial

Area of Science:

• Cardiovascular Surgery
• Clinical Trials
• Outcomes Research

Background:

• The comparative effectiveness of bilateral internal thoracic arteries (BITAs) versus single internal thoracic arteries (SITAs) in coronary artery bypass grafting (CABG) concerning age-related outcomes requires further investigation.
• Existing research has not definitively established the association between patient age and the long-term results of using BITAs compared to SITAs.

Purpose of the Study:

• To analyze the impact of age on the outcomes of patients receiving BITAs versus SITAs within the Arterial Revascularization Trial.
• To determine if age modifies the effectiveness of BITA versus SITA in CABG procedures.

Main Methods:

• The study utilized data from the Arterial Revascularization Trial, comparing BITA and SITA groups.
• Primary endpoints included all-cause mortality and a composite of major adverse events (mortality, myocardial infarction, stroke).
• Secondary endpoints assessed bleeding and sternal wound complications within six months post-surgery, employing multivariable fractional polynomials and log-rank tests.

Main Results:

• Overall, age did not significantly influence the outcomes when comparing BITA and SITA in the intention-to-treat analysis.
• In a subgroup analysis of patients aged 50-70 years, younger patients receiving BITA demonstrated a significantly lower incidence of major adverse events compared to SITA (p=0.03).

Conclusions:

• Bilateral internal thoracic arteries (BITA) show potential for improving long-term outcomes in younger patients undergoing coronary artery bypass grafting (CABG).
• Further randomized clinical trial data are necessary to validate the hypothesis that BITA confers superior long-term benefits for younger patient populations.