Abstract 2878: Bilateral Internal Thoracic Artery With Saphenous Vein Versus Total Arterial Myocardial Revascularization. A Propensity-score Matched Study
Objective. To evaluate early and long-term results of bilateral internal thoracic artery (BITA) with saphenous vein grafts (SVGs) versus BITA with at least another arterial conduit (BITA+ACs).
Methods. From September 1991 to December 2002, 1015 patients underwent first isolated coronary artery bypass grafting (CABG) for 3-vessel disease using BITA+SVGs in 643 and BITA+ACs in 372. A non-parsimonious regression model was built (c-statistic 0.901) to determine the propensity score; then, a sample matching (2:1) was performed to select 885 patients (590 BITA+SVGs vs 295 BITA+ACs) with similar pre- and operative characteristics.
Results. Thirty-day mortality was 1.8% (1.5% BITA+SVG vs 2.4% BITA+ACs, p ns); Rate of early major events was 6.9% (7.1% BITA+SVGs was 6.4% BITA+ACs, p ns). Eight-year outcomes were reported in the table⇓. Cox analysis confirmed that BITA+ACs was an independent risk variable for lower freedom from death any cause (HR=1.87, 95%CI=1.07–3.3, p=0.030) and from cardiac death (HR=3.22, 95%CI=1.32–7.80, p=0.010).
Conclusions. In patients with three-vessel disease undergoing first isolated CABG, BITA grafting provides good early and late outcome; the choice of supplementary venous grafts seem to give more stability rather than another arterial conduit which might even impair long-term outcome.