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Coronary bypass surgery with internal-thoracic-artery grafts--effects on survival over a 15-year period
A Cameron1, K B Davis, G Green
1Division of Cardiology, St. Luke's-Roosevelt Hospital Center, New York, NY 10025, USA.
Insights
Internal thoracic artery grafts offer superior long-term survival compared to saphenous vein grafts in coronary artery bypass surgery. This survival advantage increases over time, highlighting the importance of graft selection.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Clinical Outcomes
Background:
- Saphenous vein grafts are commonly used in aortocoronary bypass surgery.
- Internal thoracic artery grafts demonstrate superior patency and clinical advantages.
- The long-term persistence of these advantages is not well-established.
Purpose of the Study:
- To compare the long-term survival rates of patients undergoing coronary artery bypass grafting with internal thoracic artery grafts versus saphenous vein grafts.
- To evaluate the durability of survival benefits conferred by internal thoracic artery grafts over a 15-year period.
Main Methods:
- Retrospective analysis of patients from the Coronary Artery Surgery Study registry.
- Comparison of survival between 749 patients with internal thoracic artery grafts and 4888 patients with only saphenous vein grafts.
- 15-year follow-up period to assess survival outcomes.
Main Results:
- Internal thoracic artery grafts were an independent predictor of improved survival (relative risk of dying 0.73).
- Survival benefits were consistent across subgroups, including elderly patients and those with impaired ventricular function.
- Survival curves diverged over time, with saphenous vein grafts showing a steeper decline after eight years.
Conclusions:
- Internal thoracic artery grafts provide a significant survival advantage over saphenous vein grafts up to 15 years post-surgery.
- The survival benefit of internal thoracic artery grafts increases with time.
- Initial graft selection is a critical determinant of long-term survival in coronary artery bypass grafting.
Background:
Aortocoronary bypass surgery has been performed most often with the patient's saphenous vein as the conduit. The internal-thoracic-artery graft, which has superior patency rates, has been shown to have clinical advantages, but it is not known how long these advantages persist.
Methods:
We identified all the patients in the registry of the Coronary Artery Surgery Study who had undergone first-time coronary-artery bypass grafting. Those with internal-thoracic-artery bypass grafts (749 patients) were compared with those with saphenous-vein bypass grafts only (4888 patients) with respect to survival over a 15-year follow-up period.
Results:
In a multivariate analysis to account for differences between the two groups, the presence of an internal-thoracic-artery graft was an independent predictor of improved survival and was associated with a relative risk of dying of 0.73 (95 percent confidence interval, 0.64 to 0.83). This improved survival was also observed in subgroups including patients 65 years of age or older, both men and women, and patients with impaired ventricular function. The survival curves of the two groups showed further separation over the years of follow-up, with a more marked downsloping after eight years in the curve for the group with saphenous-vein grafts only than in that for the group with internal-thoracic-artery grafts.
Conclusions:
As compared with saphenous-vein coronary bypass grafts, internal-thoracic-artery grafts conferred a survival advantage throughout a 15-year follow-up period. The survival advantage increased with time, suggesting that the initial selection of the conduit was a more important factor in survival than problems appearing long after surgery, such as the progression of coronary disease.