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Author Spotlight: Enhancing Coronary Artery Revascularization
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Author Spotlight: Enhancing Coronary Artery Revascularization

Published on: September 15, 2023

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Bilateral Internal Thoracic Arteries Improve 10-Year Outcomes of Coronary Artery Bypass Grafting

Fabio Barili1, Francesco Onorati2, Paola D'Errigo3

  • 1Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

The Annals of Thoracic Surgery
|February 23, 2023
PubMed

Insights

Bilateral internal thoracic artery (BITA) use in coronary artery bypass grafting is linked to better 10-year survival and fewer cardiac events. However, BITA also increases the risk of surgical site infections.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Cardiac Surgery

Background:

  • Observational cohort study evaluating 10-year outcomes of bilateral internal thoracic arteries (BITA) versus single internal thoracic artery in coronary artery bypass grafting (CABG).
  • PRIORITY project merged prospective multicenter cohort studies with administrative data for long-term follow-up.
  • Primary endpoint: composite of major adverse cardiac and cerebrovascular events (MACCE) at 10 years.

Purpose of the Study:

  • To compare the 10-year efficacy and safety of BITA versus single internal thoracic artery in isolated CABG.
  • To assess the impact of BITA on long-term survival, revascularization, myocardial infarction, and surgical site complications.
  • To address selection bias in observational data using propensity score-based inverse probability treatment weighting (IPTW).

Main Methods:

  • Analysis of 10,988 patients undergoing isolated CABG.
  • BITA utilization in 23.5% of the study population.
  • IPTW applied to adjust for confounding factors and selection bias.

Main Results:

  • BITA use was associated with a lower incidence of MACCE at 10 years (adjusted HR 0.88).
  • BITA correlated with improved 10-year survival (IPTW adjusted HR 0.87), reduced re-revascularization (IPTW adjusted HR 0.83), and fewer myocardial infarctions (IPTW adjusted HR 0.86).
  • BITA use significantly increased the incidence of surgical site complications or infections (HR 2.12).

Conclusions:

  • In propensity-matched patients, BITA use improves 10-year survival, freedom from repeat revascularization, and myocardial infarction.
  • BITA use is associated with a higher incidence of surgical site complications.
  • The findings highlight a trade-off between long-term cardiac benefits and short-term infectious risks with BITA use.
Abstract

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