Abstract 4736: Revascularization With Total Arterial Grafts but Not Bilateral Internal Thoracic Arteries is Associated With Better Outcomes in High-risk Patients in Japan: Insights From Credo-Kyoto Registry
Background: Long-term benefits of arterial grafts such as internal thoracic artery (ITA) have been advocated in coronary artery bypass grafting (CABG); however, there have been few multicenter studies that investigated long-term outcomes of CABG using bilateral ITAs or total arterial grafts particularly in high-risk patients in Japan.
Methods and Results: Between 2000 and 2002, a total of 9877 Japanese patients from 30 institutions who received PCI or CABG were enrolled in CREDO-Kyoto Registry. Among them, high-risk patients (1081 with diabetes mellitus [DM] or 112 with chronic hemodialysis) who received primary CABG using ITA (67±7 y.o., 775 male) were enrolled in the present study. 333 patients received CABG using bilateral ITAs and 794 single ITA. On the other hand, 444 patients received total arterial CABG and 683 received saphenous vein graft (SVG)-combined CABG. Median follow-up was 3.4 years. Multivariate analysis with Cox proportional hazard model showed that total arterial CABG reduced the incidence of cardiovascular death (CVD, p=0.001, hazard ratio [HR]=0.42) as compared with SVG-combined one. However, using bilateral ITAs did not reduce the incidence of CVD (p=0.77) compared with single ITA. Both bilateral ITAs and total arterial CABG did not influence the incidence of any target-vessel revascularization. Subsequently, subclass analysis with Kaplan-Meier method showed that using bilateral ITAs did not reduce the incidence of CVD or composite cardiovascular event (CVD, myocardial infarction, or stroke) not only in patients with DM (p=0.79 and p=0.25) but also in hemodialysis (p=0.53 and p=0.76) as compared with patients with single ITA. On the other hand, total arterial CABG reduced the incidence of CVD in patients with DM (p=0.001). Furthermore, total arterial CABG reduced the incidence of both CVD and composite events (p=0.0081 and p=0.0093) in patients with hemodialysis as compared with those with SVG-combined CABG.
Conclusions: In Japanese population, total arterial CABG may be associated with better outcomes than SVG-combined CABG in high-risk patients with DM or hemodialysis. However, using bilateral ITAs cannot demonstrate definite advantages as compared with single ITA. Further follow-up is warranted.