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Impact of bilateral internal mammary artery grafting in patients with mildly decreased renal function
Yu Hohri1, Yanling Zhao1, Paul Kurlansky1
1Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, 177 Fort Washington Ave, New York, NY, 10019, USA.
Insights
Bilateral internal mammary artery (BIMA) grafting in coronary artery bypass grafting (CABG) improves survival and reduces adverse events in patients with mildly decreased kidney function. This approach offers better long-term outcomes compared to single IMA grafting.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Clinical Outcomes Research
Background:
- The efficacy of bilateral internal mammary artery (BIMA) grafting in multivessel coronary artery bypass grafting (CABG) remains unclear for patients with mildly reduced kidney function (GFR 60-89 ml/min/1.73 m²).
- This study investigates the comparative effectiveness of BIMA versus single internal mammary artery (SIMA) grafting in this specific patient cohort.
Purpose of the Study:
- To compare the long-term survival and major adverse cardiac or cerebrovascular events (MACCE) between BIMA and SIMA grafting in patients with mildly decreased renal function undergoing multivessel CABG.
- To evaluate the impact of BIMA versus SIMA grafting on complete revascularization rates and the number of distal anastomoses.
Main Methods:
- A retrospective analysis of 933 patients who underwent isolated primary multivessel CABG, comparing those who received BIMA (n=454) versus SIMA (n=479) grafts.
- Exclusion of patients receiving radial artery grafts or no internal mammary artery grafts.
- Application of inverse probability treatment weighting to balance cohort characteristics and assessment of 6-year survival and MACCE incidence.
Main Results:
- The BIMA group exhibited a significantly higher number of total distal anastomoses (P<0.001) but a similar rate of complete revascularization (P=0.101) compared to the SIMA group.
- Six-year survival was significantly higher in the BIMA group (91.9%) versus the SIMA group (85.9%) (P=0.046), confirmed by multivariable analysis (HR 0.505, P=0.035).
- The incidence of MACCE was substantially lower in the BIMA group (23.5%) compared to the SIMA group (40.5%) (P<0.001).
Conclusions:
- Bilateral internal mammary artery grafting is associated with improved long-term survival in patients with mildly decreased renal function undergoing multivessel CABG.
- The use of BIMA grafting significantly reduces the incidence of major adverse cardiac or cerebrovascular events in this patient population.
- BIMA grafting may be a preferred strategy for achieving better clinical outcomes in selected patients with renal impairment undergoing complex coronary revascularization.
Background:
The effectiveness of bilateral internal mammary artery (BIMA) grafting during multivessel coronary artery bypass grafting (CABG) is uncertain in patients with mildly decreased renal function (glomerular filtration rate 60-89 ml/min/1.73 m2). We compared outcomes of bilateral versus single IMA (SIMA) grafting in this population.
Methods:
We analyzed 933 patients with mildly decreased renal function who underwent isolated primary CABG using BIMA (n = 454) or SIMA (n = 479) at our center. Patients receiving radial artery grafts or no IMA grafts were excluded. Inverse probability treatment weighting was used to create a well-balanced cohort. 6-year survival and the cumulative incidence of major adverse cardiac or cerebrovascular events (MACCE)-including death, stroke, myocardial infarction, revascularization, and rehospitalization-were assessed.
Results:
The median age of the entire cohort was 68.0 years (IQR 61.5-74.0). Median follow-up time was 4.63 years (IQR 4.46-4.82). In well-balanced cohort, BIMA group had a higher number of total distal anastomoses (P < 0.001), with similar rate of complete revascularization (P = 0.101). BIMA group had significantly higher 6-year survival compared to SIMA group (91.9% [87.7-96.3%]; 85.9% [81.7-90.2%]; P = 0.046), which was reconfirmed on multivariable Cox regression analysis (Hazard ratio: 0.505 [0.268-0.953], P = 0.035). MACCE incidence was significantly lower with BIMA (23.5% vs. 40.5%, P < 0.001).
Conclusion:
Among patients with mildly decreased renal function, the BIMA group was associated with longer survival and lower major adverse cardiac or cerebrovascular events after multivessel CABG.
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