Abstract 15020: Second Arterial Graft Selection in Patients With Preserved Renal Function-Second Internal Thoracic Artery versus Radial Artery in OPCAB: Propensity Score-Matching Analysis-
Background: The best selection of second arterial graft in coronary artery bypass grafting (CABG) is still unclear. The aim of this study is to compare the clinical outcomes in patients with preserved renal function receiving bilateral internal thoracic artery (BITA) or radial artery (RA) in addition to single internal thoracic artery (SITA).
Methods: Among 707 consecutive patients undergoing isolated off-pump CABG (OPCAB) between 2000 and 2012, 239 patients had eGFR ≥60 and underwent isolated OPCAB using BITA (n = 138) or SITA + RA (n = 101) to left coronary system. By using propensity scores created based on 6 preoperative factors, 80 pairs were matched.
Results: The operation time in the SITA + RA group was significantly shorter than that in BITA group. (308min in SITA + RA group versus 344 min in BITA group, p = 0.009) The rate of postoperative complications was similar between the groups. Mean follow-up period was 6.8 years. The 5-year survival rates in BITA group and SITA + RA group were 93.0% and 92.9% (log-rank test, p = 0.95). For freedom from cardiac death, the respective rates were 100% and 98.4% at 5 years (p = 0.50). The cardiac event-free rate in BITA group was significantly higher than the rate in SITA + RA group. (The 5-year cardiac event-free rate: 97.3% in BITA group and 86.0% in SITA+RA group, p = 0.009) Cardiac events were defined as cardiac death, myocardial infarction, repeat revascularization and readmission. In multivariate Cox regression analysis, bilateral ITA grafting was significantly associated with a lower risk for cardiac event (hazard ratio, 0.22; 95% CI, 0.06 - 0.78; p = 0.02).
Conclusions: In patients with preserved renal function, the use of RA as the second arterial graft provided equivalent survival rate to the use of second ITA. But the use of BITA is associated with lower risk of cardiac event than the use of SITA and RA.
- © 2013 by American Heart Association, Inc.