Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years
Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years
复制标题
DOI：
10.1056/nejmoa1808783
复制
发表时间：
2019-01-31
影响因子：
158.5
通讯作者：
Flather, Marcus
中科院分区：
文献类型：
--
作者：
Taggart, David P.;Benedetto, Umberto;Flather, Marcus
冠状动脉旁路移植术（CABG）后，多支动脉移植物可能比单支动脉移植物的存活时间更长。我们评估了使用双侧胸廓内动脉移植CABG。METHODS我们随机分配患者进行CABG接受双侧或单胸廓内动脉移植。根据指示使用了额外的动脉或静脉移植物。主要结局为10年时任何原因导致的死亡。全因死亡、心肌梗死或卒中的复合终点为次要终点，共有1548例患者随机分为双侧胸廓内动脉移植组（双侧移植组）和1554例患者接受单侧胸廓内动脉移植组（单侧移植组）。在双侧移植物组中，13.9%的患者仅接受了单一胸廓内动脉移植物，在单一移植物组中，21.8%的患者还接受了桡动脉移植物。10年时，2.3%的患者的生命状态未知。在10年的意向治疗分析中，双侧移植组有315例死亡（20.3%的患者），单移植组有329例死亡（21.2%）（风险比，0.96; 95%置信区间[CI]，0.82 - 1.12; P = 0.62）。关于死亡、心肌梗死或卒中的复合结局，有385例患者（24.9%），双侧移植物组和425例患者发生了事件（27.3%）单移植物组发生事件（危害比，0.90; 95%可信区间，0.79 ~ 1.03）。结论：在随机分配接受双侧或单侧胸廓内动脉移植的择期CABG患者中，在意向治疗分析中，10年时任何原因导致的死亡率在组间无显著差异。需要进一步的研究来确定多动脉移植物是否比单个胸廓内动脉移植物提供更好的结果。
BACKGROUNDMultiple arterial grafts may result in longer survival than single arterial grafts after coronary-artery bypass grafting (CABG) surgery. We evaluated the use of bilateral internal-thoracic-artery grafts for CABG.METHODSWe randomly assigned patients scheduled for CABG to undergo bilateral or single internal-thoracic-artery grafting. Additional arterial or vein grafts were used as indicated. The primary outcome was death from any cause at 10 years. The composite of death from any cause, myocardial infarction, or stroke was a secondary outcome.RESULTSA total of 1548 patients were randomly assigned to undergo bilateral interna-lthoracic-artery grafting (the bilateral-graft group) and 1554 to undergo single internal-thoracic-artery grafting (the single-graft group). In the bilateral-graft group, 13.9% of the patients received only a single internal-thoracic-artery graft, and in the single-graft group, 21.8% of the patients also received a radial-artery graft. Vital status was not known for 2.3% of the patients at 10 years. In the intention-to-treat analysis at 10 years, there were 315 deaths (20.3% of the patients) in the bilateral-graft group and 329 deaths (21.2%) in the single-graft group (hazard ratio, 0.96; 95% confidence interval [CI], 0.82 to 1.12; P = 0.62). Regarding the composite outcome of death, myocardial infarction, or stroke, there were 385 patients (24.9%) with an event in the bilateral-graft group and 425 patients (27.3%) with an event in the single-graft group (hazard ratio, 0.90; 95% CI, 0.79 to 1.03).CONCLUSIONSAmong patients who were scheduled for CABG and had been randomly assigned to undergo bilateral or single internal-thoracic-artery grafting, there was no significant between-group difference in the rate of death from any cause at 10 years in the intention-to-treat analysis. Further studies are needed to determine whether multiple arterial grafts provide better outcomes than a single internal-thoracic-artery graft.