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J Thorac Cardiovasc Surg. 2011 Oct;142(4):829-35. doi: 10.1016/j.jtcvs.2010.09.063. Epub 2011 Feb 18.

The effect of internal thoracic artery grafts on long-term clinical outcomes after coronary bypass surgery.

Author information

1
Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA 94305-5405, USA. hlatky@stanford.edu

Abstract

OBJECTIVES:

We sought to compare long-term outcomes after coronary bypass surgery with and without an internal thoracic artery graft.

METHODS:

We analyzed clinical outcomes over a median follow-up of 6.7 years among 3,087 patients who received coronary bypass surgery as participants in one of 8 clinical trials comparing surgical intervention with angioplasty. We used 2 statistical methods (covariate adjustment and propensity score matching) to adjust for the nonrandomized selection of internal thoracic artery grafts.

RESULTS:

Internal thoracic artery grafting was associated with lower mortality, with hazard ratios of 0.77 (confidence interval, 0.62-0.97; P = .02) for covariate adjustment and 0.77 (confidence interval, 0.57-1.05; P = .10) for propensity score matching. The composite end point of death or myocardial infarction was reduced to a similar extent, with hazard ratios of 0.83 (confidence interval, 0.69-1.00; P = .05) for covariate adjustment to 0.78 (confidence interval, 0.61-1.00; P = .05) for propensity score matching. There was a trend toward less angina at 1 year, with odds ratios of 0.81 (confidence interval, 0.61-1.09; P = .16) in the covariate-adjusted model and 0.81 (confidence interval, 0.55-1.19; P = .28) in the propensity score-adjusted model.

CONCLUSIONS:

Use of an internal thoracic artery graft during coronary bypass surgery seems to improve long-term clinical outcomes.

PMID:
21334008
DOI:
10.1016/j.jtcvs.2010.09.063
[Indexed for MEDLINE]
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