Author + information
- Robert Tranbaugh,
- Thomas Schwann,
- Daniel Swistel,
- Kamellia Dimitrova,
- Laila Al-Shaar,
- Darryl Hoffman,
- Charles Geller,
- Sandhya Balaram,
- Wilson Ko,
- Milo Engoren and
- Robert Habib
The optimal grafting strategy during CABG is not clear beyond the LITA-LAD graft. We compared late survival in patients receiving either the radial artery (RA), right internal thoracic artery (RITA) or saphenous vein (SVG) as the preferred second graft.
Late survival data was collected for 13,130 consecutive LITA-LAD patients (65±10 yrs; 71% male; 4540 RA, 1643 RITA and 6947 SVG) from three hospitals. Early death (n=194, 1.4%) and RA+RITA patients were excluded. Propensity matching was used to obtain 1301 RA/RITA/SVG matched triplets (Total N = 3903) analyzed by Kaplan Meier analysis. Cox regression analysis was performed on all patients.
The matched triplets comparison showed superior late RA survival compared to SV (P<0.001) and to RITA (P<0.001), while the RITA and SVG groups showed similar survival overall.[Fig-Left] Comprehensive risk-adjustment via Cox regression confirmed the matched results, and demonstrated relatively superior RA vs. SVG survival irrespective of age.[Fig-Right] There was a RITA vs SVG advantage only in patients ≤65 yrs [RR (95% CI) = 0.74 (0.61-0.89)] and no difference in RA vs RITA survival across all ages.
RA as a second arterial graft vs SVG is associated with improved late survival in all patients and especially in those <70 yrs. The RITA vs SVG survival benefit is primarily in patients ≤65 yrs. The optimal grafting strategy during CABG is either a RA or RITA in addition to the LITA-LAD graft in younger patients and a RA in older patients.
West, Room 3014
Saturday, March 09, 2013, 8:45 a.m.-9:00 a.m.
Session Title: The Cutting Edge in Revascularization for SIHD
Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical
Presentation Number: 910-6
- 2013 American College of Cardiology Foundation