Abstract 16461: Does use of Bilateral Internal Mammary Artery Grafting Reduce Long-Term Risk of Repeat Coronary Revascularization? - A Multicenter Analysis
Introduction: Patients receiving bilateral internal mammary artery conduits (BIMA) during coronary artery bypass grafting (CABG) have better long-term survival than patients receiving a single internal mammary artery (IMA). A possible mechanism might be the decreased need for repeat revascularization. We sought to compare the frequency of repeat coronary revascularization among BIMA vs IMA patients.
Methods: A multi-center, retrospective analysis of 48,175 consecutive CABGs performed from 1992-2014 among 7 medical centers reporting to a prospectively maintained clinical registry was conducted. Among the study population, 1,482 CABGs with BIMA were identified and 1,297 BIMA patients were propensity matched to 1,297 IMA patients. The primary end-point was the frequency of repeat coronary revascularization.
Results: The median duration of follow up was 12 [IQR=6.5-16.5] years. Patients were well matched by age, BMI, major comorbidities, and cardiac function. There was no difference in hospital morbidity or mortality (p=0.315). Patients receiving a BIMA had a lower rate of repeat coronary revascularization when compared to patients receiving an IMA (BIMA 15.1% vs IMA 19.4%, p=0.004). There was a higher freedom from revascularization among BIMA compared to IMA (Figure, p=0.009). Event-free survival for BIMA vs IMA was 84% vs 79% at 15 years and 79% vs 73% at 20 years. The majority of revascularization procedures were PCIs (94.2%) and this did not differ between groups (p=0.274). Groups did not differ in the ratio of native vs saphenous vein PCI (p=0.899), or the targets receiving PCI, with the most common targets in both groups: RCA (p=0.133), circumflex (p=0.093), and LAD (p=0.859).
Conclusion: Use of BIMA conduits during CABG significantly reduces the long-term risk of repeat coronary revascularization with no adverse effects on in-hospital morbidity or mortality. This revascularization benefit may contribute to the better long-term survival with BIMA vs IMA.
- Coronary artery bypass grafting (CABG)
- Surgical Revascularization
- Percutaneous coronary intervention (PCI)
Author Disclosures: A. Iribarne: None. J.D. Schmoker: None. D.J. Malenka: Consultant/Advisory Board; Modest; Anthem. B.J. Leavitt: None. J.N. McCullough: None. P.W. Weldner: None. J.P. DeSimone: None. B.M. Westbrook: None. R.D. Quinn: None. J.D. Klemperer: None. G.L. Sardella: None. R.S. Kramer: None. E.M. Olmstead: None. A.W. DiScipio: None.
- © 2016 by American Heart Association, Inc.