Multiple arterial grafts improve survival with coronary artery bypass graft surgery versus conventional coronary artery bypass grafting compared with.

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From: Systematic Review: The Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Graft Surgery Ann Intern Med.

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Presentation transcript:

Multiple arterial grafts improve survival with coronary artery bypass graft surgery versus conventional coronary artery bypass grafting compared with percutaneous coronary interventions Chaim Locker, MD, Hartzell V. Schaff, MD, Richard C. Daly, MD, Joseph A. Dearani, MD, Malcolm R. Bell, MD, Robert L. Frye, MD, Kevin L. Greason, MD, John M. Stulak, MD, Lyle D. Joyce, MD, PhD, Alberto Pochettino, MD, Zhuo Li, MS, Ryan J. Lennon, MS, Amir Lerman, MD The Journal of Thoracic and Cardiovascular Surgery Volume 152, Issue 2, Pages 369-379.e4 (August 2016) DOI: 10.1016/j.jtcvs.2016.03.089 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Kaplan-Meier curve for long-term survival percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in unmatched patients. Number of patients at risk is shown below each graph. A, PCI versus CABG; hazard ratio (HR), 0.89; 95% confidence interval (CI), 0.83-0.95; P < .001. B, PCI and left internal thoracic artery (LITA)/saphenous vein (SV) versus multiple arterial coronary artery bypass grafting (MultArt): HR, 1.17; 95% CI, 0.99-1.39, P = .07; and HR, 1.35; 95% CI, 1.14-1.59; P < .001, respectively. C, bare metal stent (BMS), balloon angioplasty only (BA), drug-eluting stent (DES) and LITA/SV versus MultArt: HR, 1.18; 95% CI, 0.99-1.40, P = .07; HR, 1.26; 95% CI, 1.04-1.52, P = .02; HR, 1.04; 95% CI, 0.84-1.28, P = .73, and HR, 1.36; 95% CI, 1.15-1.60, P < .001, respectively. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 369-379.e4DOI: (10.1016/j.jtcvs.2016.03.089) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Kaplan-Meier Curve for long-term survival percutaneous coronary intervention (PCI) subgroups versus coronary artery bypass grafting (CABG) group, and PCI subgroups versus CABG subgroups in matched patients. Number of patients at risk is shown below each graph. A, balloon angioplasty only (BA) versus CABG, bare metal stent (BMS) versus CABG, and drug-eluting stent (DES) versus CABG; hazard ratio [HR], 0.99; 95% confidence interval [CI], 0.81-1.22; P = .94; HR, 0.91; 95% CI, 0.80-1.04; P = .18; and HR, 0.88; 95% CI, 0.67-1.16; P = .36, respectively. B, BA versus left internal thoracic artery (LITA)/saphenous vein (SV) <5 years: HR, 1.89; 95% CI, 1.33-2.70, P < .001, > 5 years: HR, 0.80; 95% CI, 0.61-1.04; P = .09; BMS versus LITA/SV < 5 years: HR, 1.15; 95% CI, 0.95-1.40; P = 1.51; > 5 years: HR, 0.74; 95% CI, 0.62-0.90; P = .002; and DES versus LITA/SV: HR, 0.87; 95% CI, 0.65-1.16; P = .34. C, BA versus MultArt: HR, 1.91; 95% CI, 1.27-2.88; P = .002; BMS versus MultArt <5 years: HR, 1.81; 95% CI, 1.12-2.92; P = .01; > 5 years: HR, 0.76; 95% CI, 0.47-1.21; P = .24, DES versus MultArt: HR, 0.9; 95% CI, 0.53-1.53; P = .69; and LITA/SV versus MultArt: HR, 1.46; 95% CI, 1.06-2.01; P = .02. MultArt, Multiple arterial coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 369-379.e4DOI: (10.1016/j.jtcvs.2016.03.089) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Overall CABG versus PCI-revascularization rates by year and by type of procedure during study period. CABG, Coronary artery bypass grafting; LITA, left internal thoracic artery; SVG, saphenous vein grafts; MultArt, multiple arterial coronary artery bypass grafting; PCI, percutaneous coronary intervention; BMS, bare metal stent; DES, drug-eluting stent; BA, balloon angioplasty. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 369-379.e4DOI: (10.1016/j.jtcvs.2016.03.089) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Kaplan-Meier curve for long-term survival PCI and LITA/SV versus MultArt unmatched; hazard ratio; 95% confidence interval, 1.17; 0.99-1.39, P = .07, and 1.35; 1.14-1.59, P < .001, respectively. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 369-379.e4DOI: (10.1016/j.jtcvs.2016.03.089) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Video 1 Complete arterial revascularization with the use of skeletonized bilateral internal thoracic arteries: in situ LITA to LAD and free right internal thoracic artery from side of the LITA (Composite –T graft) sequentially to ramus intermedius and left posterolateral branch of the circumflex coronary artery. Video available at http://www.jtcvsonline.org/article/S0022-5223(16)30112-X/addons. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 369-379.e4DOI: (10.1016/j.jtcvs.2016.03.089) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions