Right internal thoracic artery versus radial artery as the second best arterial conduit: Insights from a meta-analysis of propensity-matched data on long-term.

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Presentation transcript:

Right internal thoracic artery versus radial artery as the second best arterial conduit: Insights from a meta-analysis of propensity-matched data on long-term survival Umberto Benedetto, MD, PhD, Mario Gaudino, MD, Massimo Caputo, MD, Robert F. Tranbaugh, MD, Christopher Lau, MD, Antonino Di Franco, MD, Colin Ng, MBBS, Leonard N. Girardi, MD, Gianni D. Angelini, MD The Journal of Thoracic and Cardiovascular Surgery Volume 152, Issue 4, Pages 1083-1091.e15 (October 2016) DOI: 10.1016/j.jtcvs.2016.05.022 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Flow chart for study selection. RCT, Randomized controlled trial. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1083-1091.e15DOI: (10.1016/j.jtcvs.2016.05.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Forest plot comparing the effect of right internal thoracic artery (RITA) versus the radial artery (RA) on late mortality across individual studies and by means of pooled estimates. TE, Treatment effect; seTE, standard error; HR, hazard ratio; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1083-1091.e15DOI: (10.1016/j.jtcvs.2016.05.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Forest plot comparing the effect of right internal thoracic artery (RITA) versus the radial artery (RA) on operative mortality (A), incidence of sternal wound complication (B), and repeat revascularization (C) across individual studies and by means of pooled estimates. OR, Odds ratio; CI, confidence interval; TE, treatment effect; seTE, standard error. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1083-1091.e15DOI: (10.1016/j.jtcvs.2016.05.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Forest plot of the leave-one-out sensitivity analysis (left) and the radial plot (right) comparing the effect of right internal thoracic artery (RITA) versus radial artery (RA) on late mortality. HR, Hazard ratio; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1083-1091.e15DOI: (10.1016/j.jtcvs.2016.05.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Funnel plot comparing the effect of right internal thoracic artery (RITA) versus radial artery (RA) on late mortality. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1083-1091.e15DOI: (10.1016/j.jtcvs.2016.05.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Funnel plot comparing the effect of right internal thoracic artery (RITA) versus radial artery (RA) on operative mortality (A), incidence of sternal wound complication (B), and repeat revascularization (C). The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1083-1091.e15DOI: (10.1016/j.jtcvs.2016.05.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 Forest plot comparing the effect of right internal thoracic artery (RITA) versus radial artery (RA) on operative mortality in propensity matching studies and the RAPCO trial across individual studies and by means of pooled estimates. TE, Treatment effect; seTE, standard error; HR, hazard ratio; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1083-1091.e15DOI: (10.1016/j.jtcvs.2016.05.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure E4 Forest plot comparing the effect of right internal thoracic artery (RITA) versus radial artery (RA) on operative mortality in all unmatched populations. TE, Treatment effect; seTE, standard error; HR, hazard ratio; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1083-1091.e15DOI: (10.1016/j.jtcvs.2016.05.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure E5 Forest plot comparing the effect of right internal thoracic artery (RITA) versus radial artery (RA) on operative mortality according to the target. LCA, Left coronary artery; RCA, right coronary artery; TE, treatment effect; seTE, standard error; HR, hazard ratio; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1083-1091.e15DOI: (10.1016/j.jtcvs.2016.05.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

By pooling data from 8 propensity score-matching studies, the right internal thoracic artery (RITA) was found to be associated with a 25% risk reduction of late death compared with the radial artery (RA). The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1083-1091.e15DOI: (10.1016/j.jtcvs.2016.05.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions