Clinical Research Unit, Division of Cardiothoracic Surgery, Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia 30308, USA.
Ann Thorac Surg. 2012 Sep;94(3):710-5; discussion 715-6. doi: 10.1016/j.athoracsur.2012.03.082. Epub 2012 Jun 6.
This study examines if bilateral internal thoracic artery (BITA) grafting provides improved outcomes compared with single internal thoracic artery (SITA) grafting, in the modern era, in which diabetes mellitus and obesity are more prevalent.
The Society of Thoracic Surgeons database at a single large academic center was reviewed for all consecutive isolated coronary artery bypass grafting patients with two or more distal anastomoses from January 1, 2002, through December 31, 2010. Propensity-adjusted logistic and Cox regression models were used to estimate the effect of BITA on short-term outcomes and long-term survival for diabetic and nondiabetic patients.
A total of 3,527 coronary artery bypass grafting operations (812 BITA, 2,715 SITA) were performed. Fewer BITA than SITA patients had diabetes (28.6% vs 44.7% p<0.001). There was no significant difference in 30-day rates of death, stroke, or myocardial infarction between nondiabetic patients who had BITA vs SITA, or between diabetic patients who had BITA vs SITA. BITA grafting conferred a 35% reduction (95% confidence interval, 12% to 52%, p=0.006) in the long-term hazard of death equally for nondiabetic and diabetic patients (p=0.93). Deep sternal wound infection was more common among diabetic than among nondiabetic patients (1.5% vs 0.7%), but was similar within nondiabetic (1.0% vs 0.6%) and diabetic patients (1.7% vs 1.5%) who had BITA vs SITA. Overall, BITA and SITA patients had similar rates of deep sternal wound infection (1.2% vs 1.0%).
BITA grafting confers a long-term survival advantage and should be performed whenever suitable coronary anatomy exists and patient risk factors allow an acceptable risk of deep sternal wound infection.
本研究旨在探讨在糖尿病和肥胖症更为普遍的现代时代，双侧内乳动脉（BITA）搭桥与单根内乳动脉（SITA）搭桥相比是否能提供更好的结果。
回顾了 2002 年 1 月 1 日至 2010 年 12 月 31 日期间，在一家大型学术中心的胸外科医师协会数据库中，所有接受过两支或更多远端吻合的连续孤立性冠状动脉旁路移植术患者的资料。采用倾向性调整的逻辑回归和 Cox 回归模型，评估 BITA 对糖尿病和非糖尿病患者的短期结果和长期生存的影响。
共进行了 3527 例冠状动脉旁路移植术（812 例 BITA，2715 例 SITA）。与 SITA 患者相比，BITA 患者的糖尿病患者比例较低（28.6%比 44.7%，p<0.001）。在非糖尿病患者中，接受 BITA 与 SITA 的患者之间，以及糖尿病患者中接受 BITA 与 SITA 的患者之间，30 天死亡率、中风或心肌梗死的发生率无显著差异。BITA 搭桥术同样使非糖尿病和糖尿病患者的长期死亡风险降低了 35%（95%置信区间，12%至 52%，p=0.006）（p=0.93）。糖尿病患者的深部胸骨伤口感染发生率高于非糖尿病患者（1.5%比 0.7%），但在非糖尿病患者（1.0%比 0.6%）和糖尿病患者（1.7%比 1.5%）中，接受 BITA 与 SITA 的患者之间，深部胸骨伤口感染的发生率相似。总的来说，BITA 和 SITA 患者的深部胸骨伤口感染发生率相似（1.2%比 1.0%）。
BITA 搭桥术可带来长期生存优势，只要存在合适的冠状动脉解剖结构，且患者的危险因素允许接受可接受的深部胸骨伤口感染风险，就应进行搭桥术。
