Bilateral versus single internal-thoracic-artery grafts at 10 years

David P. Taggart; Umberto Benedetto; Stephen Gerry; Douglas G. Altman; Alastair M. Gray; Belinda Lees; Mario Gaudino; Vipin Zamvar; Andrzej Bochenek; Brian Buxton; Cliff Choong; Stephen Clark; Marek Deja; Jatin Desai; Ragheb Hasan; Marek Jasinski; Peter O'Keefe; Fernando Moraes; John Pepper; Siven Seevanayagam; Catherine Sudarshan; Uday Trivedi; Stanislaw Wos; John Puskas; Marcus Flather; Arterial Revascularization Trial investigators

doi:10.1056/NEJMoa1808783

Bilateral versus single internal-thoracic-artery grafts at 10 years

David P. Taggart, Umberto Benedetto, Stephen Gerry, Douglas G. Altman, Alastair M. Gray, Belinda Lees, Mario Gaudino, Vipin Zamvar, Andrzej Bochenek, Brian Buxton, Cliff Choong, Stephen Clark, Marek Deja, Jatin Desai, Ragheb Hasan, Marek Jasinski, Peter O'Keefe, Fernando Moraes, John Pepper, Siven SeevanayagamCatherine Sudarshan, Uday Trivedi, Stanislaw Wos, John Puskas, Marcus Flather, Arterial Revascularization Trial investigators

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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.

Original language	English
Pages (from-to)	437-446
Number of pages	10
Journal	New England Journal of Medicine
Volume	380
Issue number	5
DOIs	https://doi.org/10.1056/NEJMoa1808783
Publication status	Published - 31 Jan 2019

Keywords

Aged
Cause of Death
Coronary Artery Bypass/methods
Coronary Artery Disease/mortality
Female
Follow-Up Studies
Humans
Intention to Treat Analysis
Male
Mammary Arteries/transplantation
Middle Aged
Myocardial Infarction/epidemiology
Stroke/epidemiology
Survival Analysis

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10.1056/NEJMoa1808783

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Cite this

Taggart, D. P., Benedetto, U., Gerry, S., Altman, D. G., Gray, A. M., Lees, B., Gaudino, M., Zamvar, V., Bochenek, A., Buxton, B., Choong, C., Clark, S., Deja, M., Desai, J., Hasan, R., Jasinski, M., O'Keefe, P., Moraes, F., Pepper, J., ... Arterial Revascularization Trial investigators (2019). Bilateral versus single internal-thoracic-artery grafts at 10 years. New England Journal of Medicine, 380(5), 437-446. https://doi.org/10.1056/NEJMoa1808783

@article{4062856384e04fe5ad4f876da76449bb,

title = "Bilateral versus single internal-thoracic-artery grafts at 10 years",

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. ",

keywords = "Aged, Cause of Death, Coronary Artery Bypass/methods, Coronary Artery Disease/mortality, Female, Follow-Up Studies, Humans, Intention to Treat Analysis, Male, Mammary Arteries/transplantation, Middle Aged, Myocardial Infarction/epidemiology, Stroke/epidemiology, Survival Analysis",

author = "Taggart, {David P.} and Umberto Benedetto and Stephen Gerry and Altman, {Douglas G.} and Gray, {Alastair M.} and Belinda Lees and Mario Gaudino and Vipin Zamvar and Andrzej Bochenek and Brian Buxton and Cliff Choong and Stephen Clark and Marek Deja and Jatin Desai and Ragheb Hasan and Marek Jasinski and Peter O'Keefe and Fernando Moraes and John Pepper and Siven Seevanayagam and Catherine Sudarshan and Uday Trivedi and Stanislaw Wos and John Puskas and Marcus Flather and {Arterial Revascularization Trial investigators}",

year = "2019",

month = jan,

day = "31",

doi = "10.1056/NEJMoa1808783",

language = "English",

volume = "380",

pages = "437--446",

journal = "New England Journal of Medicine",

issn = "0028-4793",

publisher = "Massachussetts Medical Society",

number = "5",

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Taggart, DP, Benedetto, U, Gerry, S, Altman, DG, Gray, AM, Lees, B, Gaudino, M, Zamvar, V, Bochenek, A, Buxton, B, Choong, C, Clark, S, Deja, M, Desai, J, Hasan, R, Jasinski, M, O'Keefe, P, Moraes, F, Pepper, J, Seevanayagam, S, Sudarshan, C, Trivedi, U, Wos, S, Puskas, J, Flather, M & Arterial Revascularization Trial investigators 2019, 'Bilateral versus single internal-thoracic-artery grafts at 10 years', New England Journal of Medicine, vol. 380, no. 5, pp. 437-446. https://doi.org/10.1056/NEJMoa1808783

TY - JOUR

T1 - Bilateral versus single internal-thoracic-artery grafts at 10 years

AU - Taggart, David P.

AU - Benedetto, Umberto

AU - Gerry, Stephen

AU - Altman, Douglas G.

AU - Gray, Alastair M.

AU - Lees, Belinda

AU - Gaudino, Mario

AU - Zamvar, Vipin

AU - Bochenek, Andrzej

AU - Buxton, Brian

AU - Choong, Cliff

AU - Clark, Stephen

AU - Deja, Marek

AU - Desai, Jatin

AU - Hasan, Ragheb

AU - Jasinski, Marek

AU - O'Keefe, Peter

AU - Moraes, Fernando

AU - Pepper, John

AU - Seevanayagam, Siven

AU - Sudarshan, Catherine

AU - Trivedi, Uday

AU - Wos, Stanislaw

AU - Puskas, John

AU - Flather, Marcus

AU - Arterial Revascularization Trial investigators

PY - 2019/1/31

Y1 - 2019/1/31

N2 - 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.

AB - 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.

KW - Aged

KW - Cause of Death

KW - Coronary Artery Bypass/methods

KW - Coronary Artery Disease/mortality

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Intention to Treat Analysis

KW - Male

KW - Mammary Arteries/transplantation

KW - Middle Aged

KW - Myocardial Infarction/epidemiology

KW - Stroke/epidemiology

KW - Survival Analysis

U2 - 10.1056/NEJMoa1808783

DO - 10.1056/NEJMoa1808783

M3 - Article

C2 - 30699314

VL - 380

SP - 437

EP - 446

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 5

ER -