Author + information
- Daniel Thuijs1,
- Gregg Stone2,
- Patrick Serruys3,
- William Brown4,
- Piet Willem Boonstra5,
- Nicolas Noiseux6,
- Ovidiu Dressler7,
- Joseph Sabik8 and
- A. Pieter Kappetein1
- 1Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- 2Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
- 3Imperial College, London, United Kingdom
- 4Piedmont Heart Institute CardioThoracic Surgeons, Atlanta, Georgia, United States
- 5Medisch Centrum Leeuwarden, Heart Center, Leeuwarden PObox 888, Netherlands
- 6Montreal Heart Institute, Montreal, Quebec, Canada
- 7Cardiovascular Research Foundation, New York, New York, United States
- 8Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, United States
Whether the use of a single internal thoracic artery (SITA) vs. bilateral internal thoracic artery (BITA) is safe and effective in patients with left main (LM) disease undergoing CABG is uncertain.
The EXCEL trial compared PCI with everolimus-eluting stents versus CABG in 1905 patients undergoing LM revascularization. Of 908 patients undergoing CABG, 643 (70.8 %) received SITA and 265 (29.2%) received BITA. The 3-year post-operative outcomes including death, MI, stroke and ischemia-driven revascularization were compared. Differences in event rates were estimated using Kaplan-Meier curves and log-rank test. Stepwise multivariable Cox regression was used to adjust for covariates.
In unadjusted analysis (Figure), the 3-year primary endpoint of death, MI or stroke occurred in 16.1% of SITA vs. 11.6% of BITA patients (p=0.09). The BITA group had significantly lower 3-year all-cause mortality rate compared to the SITA group (2.8% vs. 7.8%; p=0.01). However, almost half of the deaths in the SITA-group were non-cardiovascular (SITA 3.0% vs. BITA 0.8%, p=0.17). After adjusting for confounding factors, risk of mortality was not significantly higher with SITA (HR 1.97, 95% CI [0.87–4.45]; p=0.10), nor was the composite of death, MI or stroke significantly different (HR 1.24, 95% CI [0.80–1.92]; p=0.33). Sternal wound dehiscence did not occur more often in BITA compared to the SITA group (1.5% vs. 2.3% respectively, p=0.43).
In the EXCEL trial, among patients with LM disease undergoing CABG, use of SITA and BITA were equally safe and effective at an intermediate term follow-up of 3 years.
CORONARY: Cardiac Surgery