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Time-Varying Association of the Second Internal Thoracic Artery with Long-Term Survival after Coronary Artery Bypass
Ibrahim Gadelkarim1, Mateo Marin-Cuartas1, Sergey Leontyev1
1University Department of Cardiac Surgery, Heart Center Leipzig, Sachsen, Leipzig, Germany.
Insights
Bilateral internal thoracic artery (BITA) grafting in coronary artery bypass grafting (CABG) surgery offers superior long-term survival compared to single internal thoracic artery (SITA) grafts. This survival advantage persists for over 10 years, demonstrating BITA
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- The long-term survival benefits of bilateral internal thoracic artery (BITA) grafts versus single internal thoracic artery (SITA) grafts in coronary artery bypass grafting (CABG) remain incompletely understood.
- Optimizing graft selection is crucial for improving long-term outcomes in patients with stable multivessel coronary artery disease.
Purpose of the Study:
- To systematically evaluate the time-dependent impact of BITA grafting on long-term survival in elective CABG patients with stable multivessel coronary artery disease.
- To compare the survival outcomes of BITA versus SITA grafting, including those with additional vein grafts.
Main Methods:
- Retrospective analysis of 3,693 patients undergoing isolated CABG between 2002 and 2012, divided into BITA and SITA groups.
- Propensity score matching (1:3) was performed for the entire cohort, with a subgroup (n=1,339) meeting Randomized comparison of the clinical Outcome of single versus Multiple Arterial grafts (ROMA) trial criteria undergoing 1:1 matching.
- Restricted mean survival time (RMST) was used to assess time-varying survival differences between BITA and SITA groups.
Main Results:
- In-hospital mortality and major postoperative complications were similar between matched BITA and SITA groups.
- Long-term survival was significantly higher in the BITA group for both the entire matched cohort (15-year survival: 64% vs. 51%) and the ROMA-like population (76% vs. 60%).
- RMST analysis revealed an incremental survival advantage for BITA over SITA grafting, extending beyond 5 years for the whole cohort and beyond 10 years for the ROMA-like population.
Conclusions:
- Bilateral internal thoracic artery (BITA) grafting is a safe and effective strategy in coronary artery bypass grafting (CABG).
- BITA grafting is associated with superior long-term survival compared to single internal thoracic artery (SITA) and vein grafts.
- The survival benefits of BITA grafting are durable, extending significantly beyond 5–10 years post-surgery.
Abstract:
The survival advantages of bilateral internal thoracic artery (BITA) grafts in coronary artery bypass grafting (CABG) surgery remain unclear. Therefore, this study aims to systematically evaluate the time-dependent influence of BITA on long-term survival in elective CABG patients presenting with stable multivessel coronary artery disease.Data from 3,693 patients undergoing isolated CABG with single internal thoracic artery (SITA) or BITA, with or without additional vein grafts, between 2002 and 2012 were retrospectively analyzed. The entire cohort was divided into BITA and SITA groups (830 vs. 2,863 patients). A 1:3 propensity score matching was performed. Subsequent analysis of a subgroup meeting Randomized comparison of the clinical Outcome of single versus Multiple Arterial grafts (ROMA) trial criteria (n = 1,339) followed a 1:1 matching. Differences in restricted mean survival time (RMST) estimates were used to assess the time-varying association of BITA with long-term survival.In-hospital mortality (SITA 1.8% vs. BITA 1.1%, p = 0.2) and major postoperative complications were similar between the matched groups. However, long-term survival was significantly higher in BITA patients for the matched whole cohort (15-year survival: 64 vs. 51%, respectively; p < 0.001) and the ROMA-like population (76 vs. 60%, respectively; p < 0.001). RMST demonstrated an incremental survival advantage of BITA over SITA grafting over time for both the whole and ROMA-like populations (0.1, 0.5, and 1.1 years, and 0.1, 0.4, and 1.0 years at 5-, 10-, and 15-year follow-up, respectively)BITA grafting is safe and associated with superior long-term survival compared with SITA and vein grafts, with benefits extending beyond 5 years for the entire cohort and beyond 10 years for ROMA criteria patients.
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