Late outcomes after radial artery versus saphenous vein grafting during reoperative coronary artery bypass surgery Anoar Zacharias, MD, Thomas A. Schwann,

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Presentation transcript:

Late outcomes after radial artery versus saphenous vein grafting during reoperative coronary artery bypass surgery Anoar Zacharias, MD, Thomas A. Schwann, MD, Christopher J. Riordan, MD, Samuel J. Durham, MD, Aamir S. Shah, MD, Milo Engoren, MD, Robert H. Habib, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 139, Issue 6, Pages 1511-1518.e4 (June 2010) DOI: 10.1016/j.jtcvs.2009.07.068 Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Top, Year of initial coronary artery bypass grafting (CABG) surgery data with the corresponding incidence of internal thoracic artery (ITA) grafting. Bottom, Interval between the first and reoperative CABG operations for the entire study population and its radial artery (RA) and saphenous vein (SV) subcohorts. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1511-1518.e4DOI: (10.1016/j.jtcvs.2009.07.068) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Top, Overall (n = 347, gray line) and late (n = 314, black line) Kaplan–Meier survival for reoperative coronary artery bypass grafting (CABG). Error bars represent the standard error (Std. Err.) survival estimates at selected time points (1, 2, 4, 6, 8, and 10 years). The black line through the overall Kaplan-Meier data represents the multiphase model fit. The insert shows early-phase mortality. Bottom, Early, late, and overall hazard functions based on the multiphase model fit shown in the top panel. Early hazard values approached late hazard values at approximately 90 days, which was then used to time segment early and late survival. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1511-1518.e4DOI: (10.1016/j.jtcvs.2009.07.068) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Comparison of unadjusted late survival after reoperative coronary artery bypass grafting (CABG) for patients with radial artery grafts (RA) versus those with saphenous vein grafts (SV) and no radial grafts. Top, All patients; middle, patients with no internal thoracic artery (ITA) grafts at reoperation; bottom, patients with ITA grafts at reoperation. P values were determined by using the Breslow (generalized Wilcoxon) test. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1511-1518.e4DOI: (10.1016/j.jtcvs.2009.07.068) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Comparison of risk-adjusted late coronary artery bypass grafting (CABG) survival after reoperative CABG for the radial artery (RA) versus saphenous vein (SV) grafting method subcohorts. Risk adjustment was done with an RA-use propensity score adjustment. The shown RA and SV survival patterns represent model predictions computed at the mean of covariates based on the Cox regression analysis results. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1511-1518.e4DOI: (10.1016/j.jtcvs.2009.07.068) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Kaplan–Meier survival comparison for matched (top, 97 patients each) and unmatched (middle) patients in the radial artery (RA) versus saphenous vein (SV) cohorts in whom matching was done with the RA-use propensity score. Bottom, Distribution of propensity scores among the RA (black bars) and SV (white bars) subcohorts. Error bars represent the standard error survival estimates at selected time points. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1511-1518.e4DOI: (10.1016/j.jtcvs.2009.07.068) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Kaplan–Meier comparisons for propensity score quintile groups Kaplan–Meier comparisons for propensity score quintile groups. A summary of results at 5 and 10 years is also provided in Table 4 of the article. SV, Saphenous vein; RA, radial artery; CABG, coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1511-1518.e4DOI: (10.1016/j.jtcvs.2009.07.068) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions