Bilateral versus single internal mammary coronary artery bypass grafting in Sweden from 1997-2008.

Luca Testa,Magnus Dalén,Torbjörn Ivert,Martin J Holzmann,Ulrik Sartipy

doi:10.1371/journal.pone.0086929

Luca Testa, Magnus Dalén + Show 3 more

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https://doi.org/10.1371/journal.pone.0086929

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Journal: PloS one	Publication Date: Jan 21, 2014
Citations: 40	License type: CC BY 4.0

Affiliation: Karolinska University Hospital, Karolinska Institutet

Abstract

BackgroundPrior observational studies have suggested better outcomes in patients who receive bilateral internal mammary arteries (BIMA) during coronary artery bypass grafting (CABG) compared with patients who receive a single internal mammary artery (SIMA). The aim of this study was to analyze the association between BIMA use and long-term survival in patients who underwent primary isolated CABG.Methods and ResultsPatients who underwent primary isolated non-emergent CABG in Sweden between 1997 and 2008 were identified. The SWEDEHEART registry and other national Swedish registers were used to acquire information about patient characteristics and outcomes. Unadjusted and multivariable adjusted regression models were used to estimate the association between BIMA use and early mortality, long-term survival, and a composite of death from any cause or rehospitalization for myocardial infarction, heart failure, or stroke in the overall cohort and in a propensity score-matched cohort. The study population consisted of 49702 patients who underwent CABG with at least one internal mammary artery, and 559 (1%) of those had BIMA grafting. In the adjusted analyses, BIMA use was not associated with better survival compared with SIMA use in the overall cohort (hazard ratio (HR) for death: 1.16, 95% confidence interval (CI): 0.97 to 1.37) or in the matched cohort (HR: 1.04, 95% CI: 0.78 to 1.40). The results were similar for early mortality and the composite endpoint. Reoperation for sternal wound complications was more common among BIMA patients (odds ratio: 1.71, 95% CI: 1.01 to 2.88).ConclusionsBIMA grafting was performed infrequently and was not associated with better outcomes compared with SIMA grafting in patients undergoing non-emergent primary isolated CABG in Sweden during 1997–2008.

Highlights

Prior observational studies have suggested improved morbidity and mortality rates in patients who receive bilateral internal mammary arteries (BIMA) during coronary artery bypass surgery (CABG) compared with patients who receive a single internal mammary artery (SIMA) [1,2,3,4,5,6,7,8,9,10,11,12,13]
BIMA grafting was performed infrequently and was not associated with better outcomes compared with SIMA grafting in patients undergoing non-emergent primary isolated coronary artery bypass grafting (CABG) in Sweden during 1997–2008
We excluded 1234 patients who had previous cardiac surgery, 9509 patients who had another cardiac procedure in addition to CABG, 2434 patients who underwent emergency surgery, defined as surgery within 24 hours of decision, and 6362 patients in whom an internal mammary artery was not used or who had less than two grafted coronary arteries

Summary

Introduction

Prior observational studies have suggested improved morbidity and mortality rates in patients who receive bilateral internal mammary arteries (BIMA) during coronary artery bypass surgery (CABG) compared with patients who receive a single internal mammary artery (SIMA) [1,2,3,4,5,6,7,8,9,10,11,12,13]. The 2010 European Society of Cardiology/European Association for Cardiothoracic Surgery guidelines on myocardial revascularization state that complete revascularization with arterial grafting to non-LAD coronary systems is indicated in patients with reasonable life expectancy [10] This statement received a class I A recommendation even though no randomized trial has been conducted to support this recommendation.

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