Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York City, New York, USA; ; The Collaborative Research (CORE) Group, Sydney, Australia;
Ann Cardiothorac Surg. 2013 Jul;2(4):390-400. doi: 10.3978/j.issn.2225-319X.2013.07.16.
Increasing evidence continues to demonstrate a survival advantage for bilateral internal mammary artery (BIMA) over left internal mammary artery (LIMA) for coronary artery bypass grafting (CABG). We performed an updated meta-analysis of published studies comparing BIMA versus LIMA in CABG operations and assessed differences in long-term survival.
Electronic searches for studies comparing BIMA versus LIMA were performed using three databases from 1972 to December 2012. Studies with at least four years of follow-up and at least 100 patients in each group were included for review. We used a random-effect model and pooled hazard ratios from across all included studies.
No randomized controlled trials and 27 observational studies totaling 79,063 patients (19,277 BIMA, 59,786 LIMA) were included for final analysis. The BIMA group demonstrated significantly better long-term survival than the LIMA group [hazard ratio, 0.78; confidence interval, 0.72-0.84; P<0.00001].
In an updated meta-analysis, we demonstrate an increase in long-term survival in patients receiving BIMA as a primary grafting strategy over those receiving a LIMA. Although no randomized controlled trials were included in this meta-analysis, the survival benefit seen with a BIMA cannot be overlooked when determining which operation to perform in CABG patients. Until the long-term results of the ART trial are published, we offer best available evidence in favor of BIMA over LIMA for CABG surgery.
越来越多的证据表明，在冠状动脉旁路移植术（CABG）中，双侧内乳动脉（BIMA）比左内乳动脉（LIMA）具有生存优势。我们对已发表的比较 CABG 中 BIMA 与 LIMA 的研究进行了更新的荟萃分析，并评估了长期生存的差异。
从 1972 年到 2012 年 12 月，我们使用三个数据库对比较 BIMA 与 LIMA 的研究进行了电子检索。纳入的研究需要至少有 4 年的随访时间，每组至少有 100 例患者。我们使用随机效应模型和汇总所有纳入研究的风险比。
没有随机对照试验，有 27 项观察性研究共纳入 79063 例患者（BIMA 组 19277 例，LIMA 组 59786 例）进行最终分析。BIMA 组的长期生存率显著优于 LIMA 组[风险比，0.78；置信区间，0.72-0.84；P<0.00001]。
在更新的荟萃分析中，我们证明了接受 BIMA 作为主要移植策略的患者比接受 LIMA 的患者的长期生存率有所提高。尽管这项荟萃分析中没有纳入随机对照试验，但在确定对 CABG 患者进行哪种手术时，BIMA 带来的生存获益不容忽视。在 ART 试验的长期结果公布之前，我们提供了支持 BIMA 优于 LIMA 用于 CABG 手术的最佳现有证据。
