Association of age with 10-year outcomes after coronary surgery in the Arterial Revascularization Trial

Mario Gaudino, Antonino Di Franco, Marcus Flather, Stephen Gerry, Emilia Bagiella, Alastair Gray, Leon Pearcey, Teng-Hui Saw, Belinda Lees, Umberto Benedetto, Stephen E. Fremes, David P. Taggart

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Background: The association of age with the outcomes of bilateral internal thoracic arteries (BITAs) versus single internal thoracic arteries (SITAs) for coronary bypass grafting (CABG) remains to be determined.

Objectives: The purpose of this study was to evaluate the association between age and BITA versus SITA outcomes in the Arterial Revascularization Trial.

Methods: The primary endpoints were all-cause mortality and a composite of major adverse events, including all-cause mortality, myocardial infarction, or stroke. Secondary endpoints were bleeding complications and sternal wound complications up to 6 months after surgery. Multivariable fractional polynomials analysis and log-rank tests were used.

Results: Age did not affect any of the explored outcomes in the overall BITA versus SITA comparison in the intention-to-treat analysis and in the analysis based on the number of arterial grafts received. However, when the intention-to-treat analysis was restricted to the populations of patients between age 50 and 70 years, younger patients in the BITA arm had a significantly lower incidence of major adverse events (p = 0.03).

Conclusions: Our results suggest that BITA may improve long-term outcome in younger patients, although more randomized data are needed to confirm this hypothesis.
Original languageEnglish
Pages (from-to)18-26
Number of pages9
JournalJournal of the American College of Cardiology
Issue number1
Early online date4 Jan 2021
Publication statusPublished - 5 Jan 2021


  • CABG
  • bilateral internal thoracic arteries
  • single internal thoracic artery

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