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N Engl J Med. 2019 Jan 31;380(5):437-446. doi: 10.1056/NEJMoa1808783.

Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years.

Collaborators (248)

Ratnatunga C, Westaby S, Cook J, Wallis C, Widenka K, Blach A, Gocol R, Hudziak D, Zurek P, Bachowski R, Mrozek R, Kargul T, Domarardzki W, Frackiewicz J, Ezakadan D, Matalanis G, Rosalion A, Negri J, Moten S, Atkinson V, Newcomb A, Polidano P, Pana R, Gerbo S, von Oppell U, Mehta D, Azzu A, Szafranek A, Kulatilake E, Evans J, Martin N, Banner D, Forsyth A, Hyde J, Cohen A, Lewis M, Gardner E, MacKenzie A, Cooter N, Joyce E, Parker J, Champney F, Dark J, Tocewicz K, Pillay T, Rowling S, Adams-Hall J, Cisowski M, Bolkowski M, Morawski W, Guc M, Krejca M, Wilczynski M, Duralek A, Gerber W, Skarysz J, Shrestha R, Swiech W, Szmagala P, Krzych L, Pawlak A, Kepa K, Keenan D, Prendergast B, Odom N, McLaughlin K, Cummings-Fosong G, Mathew C, Iles-Smith H, Oomen A, El-Gamel A, John L, Wendler O, Andrews M, Rance K, Williams R, Hogervorst V, Gregory J, Jessup J, Knighton A, Hoare A, Ritchie A, Nair S, Jenkins D, Large S, Barman M, Dhital K, Routledge T, Rosengard B, Munday H, Rintoul K, Jarrett E, Lao-Sirieix S, Wilkinson A, Garner L, Osmond J, Holcombe H, Cale A, Griffin S, Dickson J, Spyt T, Gershlick A, Hickey M, Sosnowski A, Peek G, Szostek J, Hadjinikalaou, L, Logtens E, Oakley M, Leji S, Gaer J, Amrani M, Dreyfus G, Bahrami T, de Robertis F, Baig K, Asimakopoulos G, Vohra H, Pai V, Tadjkarimi S, Soleimani, Stavri G, Bull G, Collappen H, Sadowksi J, Kapelak B, Gaweda B, Rudzinski P, Stolinski J, Konstanty-Kalandyk J, Moraes C, Wanderley J, De Souza A, Petrou M, Trimlett R, Morgan T, Gavino J, Wang SF, Chandrasekaran V, Kanagasaby R, Sarsam M, Ryan H, Billings L, Ruddick L, Achampong A, Forster E, Mohama E, Mc Donnell P, Pawlaczyk R, Siondalski P, Rogowski J, Roszak K, Jarmoszewicz K, Jagielak D, Gafka S, Mannam G, Rao Sajja L, Raju Dandu B, Naguboyina G, Yalla A, Peddireddy J, Briffa N, Braidley P, Cooper G, Allen K, Sangha G, Bridge C, McMellon H, Shaw P, Casabona R, Actis Dato G, Bardi G, Del Ponte S, Forsennati, Parisi F, Punta G, Flocco R, Sansone F, Zingarelli E, Demartino A, Dihmis W, Kuduvali M, Prince C, Rogers H, McQuade L, Duran-Rosas A, Anisimowicz L, Bokszanski M, Pawliszak W, Kolakowski J, Lau G, Ogorzeja W, Gumanska I, Kulinski P, Podesser B, Trescher K, Bernecker O, Holzinger C, Binder K, Schor I, Bergmann P, Kassal H, Dunkel E, Trehan N, Meharwal Z, Malhotra R, Goel M, Kumer B, Bazaz S, Bake N, Singh A, Mishka Y, Gupta R, Basumatary S, Zembala M, Szafron B, Pacholewicz J, Krason M, Farmas A, Wojarski J, Zych B, Jaworska I, Szymanik I, Kolwca M, Mazur W, Kurowicki A, Zurek S, Stacel T, Sleight P, Channon K, Farrell B, Stables R, Vermes G, Pearson J, Pitman M, Yusuf S, Pocock S, Julian D, Treasure T, Von Oppel U, Kanagasabay R, Collinson J, Bakhai A, O’Hanlon R, Kotecha D, Qureshi K, Geisler T, Manzano-Espinosa L.

Author information

1
From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.).

Abstract

BACKGROUND:

Multiple arterial grafts may result in longer survival than single arterial grafts after coronary-artery bypass grafting (CABG) surgery. We evaluated the use of bilateral internal-thoracic-artery grafts for CABG.

METHODS:

We randomly assigned patients scheduled for CABG to undergo bilateral or single internal-thoracic-artery grafting. Additional arterial or vein grafts were used as indicated. The primary outcome was death from any cause at 10 years. The composite of death from any cause, myocardial infarction, or stroke was a secondary outcome.

RESULTS:

A total of 1548 patients were randomly assigned to undergo bilateral internal-thoracic-artery grafting (the bilateral-graft group) and 1554 to undergo single internal-thoracic-artery grafting (the single-graft group). In the bilateral-graft group, 13.9% of the patients received only a single internal-thoracic-artery graft, and in the single-graft group, 21.8% of the patients also received a radial-artery graft. Vital status was not known for 2.3% of the patients at 10 years. In the intention-to-treat analysis at 10 years, there were 315 deaths (20.3% of the patients) in the bilateral-graft group and 329 deaths (21.2%) in the single-graft group (hazard ratio, 0.96; 95% confidence interval [CI], 0.82 to 1.12; P=0.62). Regarding the composite outcome of death, myocardial infarction, or stroke, there were 385 patients (24.9%) with an event in the bilateral-graft group and 425 patients (27.3%) with an event in the single-graft group (hazard ratio, 0.90; 95% CI, 0.79 to 1.03).

CONCLUSIONS:

Among patients who were scheduled for CABG and had been randomly assigned to undergo bilateral or single internal-thoracic-artery grafting, there was no significant between-group difference in the rate of death from any cause at 10 years in the intention-to-treat analysis. Further studies are needed to determine whether multiple arterial grafts provide better outcomes than a single internal-thoracic-artery graft. (Funded by the British Heath Foundation and others; Current Controlled Trials number, ISRCTN46552265 .).

PMID:
30699314
DOI:
10.1056/NEJMoa1808783
[Indexed for MEDLINE]

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