Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Cardiac Surgery, Herzzentrum Universität Leipzig, Leipzig, Germany.
J Thorac Cardiovasc Surg. 2015 Sep;150(3):597-606.e2. doi: 10.1016/j.jtcvs.2015.05.010. Epub 2015 May 8.
Despite various evidence supporting the advantages of multiple arterial grafting, inconsistencies in use of the procedure have resulted in high variability in the acceptance and practice of arterial grafting. The purpose of this study was to assess the effects of an arterial versus venous second grafts on outcomes at 5-year follow-up in the coronary artery bypass grafting population from the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial.
Patients (n = 1419) with an arterial graft to the left anterior descending artery and ≥1 other graft were included and divided according to the second graft's type: 2nd-graft-arterial group (n = 456) and 2nd-graft-venous group (n = 963). Five-year outcomes were compared between subgroups. Event rates were estimated with Kaplan-Meier analyses. Propensity-score matching was used, to control for selection bias due to nonrandom group assignment in a 1:1 manner, resulting in 432 pairs with balanced baseline characteristics.
In unmatched groups, the 2nd-graft-arterial group had significantly lower rates of death (8.9% vs 13.1%; P = .02), and composite safety endpoint of death/stroke/myocardial infarction (13.3% vs 18.7%; P = .02), compared with the 2nd-graft-venous group. The rate of major adverse cardiac or cerebrovascular events was similar between groups (22.9% vs 25.5%; P = .30), because it includes the rate of repeat revascularization (12.6% in the 2nd-graft-arterial group vs 9.6% in the 2nd-graft-venous group; P = .10). After propensity-score matching, no statistically significant differences were found between groups.
This study reveals comparable 5-year outcomes with arterial and venous conduits as second grafts after an arterial graft anastomosed to the left anterior descending artery. This study demonstrates the multi-institutional variation in patient selection and operator technique with regard to arterial revascularization, although extended follow-up beyond 5 years is required to estimate its impact on long-term outcomes.
NCT00114972.
尽管有大量证据表明多支动脉旁路移植术具有优势，但该手术的应用不一致导致动脉旁路移植术的接受和实施存在高度差异。本研究旨在评估在 SYNTAX 试验的冠状动脉旁路移植术人群中，与静脉第二支移植物相比，动脉第二支移植物对 5 年随访结果的影响。
纳入了有左前降支动脉吻合的动脉移植物且至少有其他 1 支移植物的患者（n=1419），根据第二支移植物的类型进行分组：第二支动脉移植物组（n=456）和第二支静脉移植物组（n=963）。比较亚组之间的 5 年结果。使用 Kaplan-Meier 分析估计事件发生率。采用倾向评分匹配（1:1）以控制因非随机分组而导致的选择偏倚，从而得到 432 对基线特征均衡的配对。
在未匹配组中，与第二支静脉移植物组相比，第二支动脉移植物组的死亡率（8.9% vs. 13.1%；P=.02）和复合安全终点（死亡/卒中/心肌梗死；13.3% vs. 18.7%；P=.02）显著降低。两组之间主要不良心脏或脑血管事件的发生率相似（22.9% vs. 25.5%；P=.30），因为其包括重复血运重建的发生率（第二支动脉移植物组 12.6%，第二支静脉移植物组 9.6%；P=.10）。经过倾向评分匹配后，两组之间没有统计学差异。
本研究表明，在左前降支吻合的动脉移植物后，作为第二支移植物，动脉和静脉移植物具有相似的 5 年结果。本研究表明，尽管需要 5 年以上的随访来估计其对长期结果的影响，但动脉再血管化在患者选择和术者技术方面存在多机构差异。
NCT00114972。
