Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom; Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY.
Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom.
J Thorac Cardiovasc Surg. 2017 Jan;153(1):79-88.e4. doi: 10.1016/j.jtcvs.2016.08.060. Epub 2016 Sep 12.
We conducted propensity score matching to determine whether the use of the right internal thoracic artery (RITA) confers a survival advantage when compared with the radial artery (RA) as second arterial conduit in coronary artery bypass grafting.
The study population included a highly selected low-risk group of patients who received the RITA (n = 764) or the RA (n = 1990) as second arterial conduit. We obtained 764 matched pairs that were comparable for all pretreatment variables. A time-segmented Cox regression model that stratified on the matched pairs was used to investigate the effect of treatment on late mortality.
After a mean follow-up of 10.2 ± 4.5 years (maximum 17.3 years), survival probabilities at 5, 10, and 15 years were 96.4% ± 0.7% versus 95.4% ± 0.7%, 91.0% ± 1.1% versus 89.1% ± 1.2%, and 82.4% ± 1.9% versus 77.2% ± 2.5% in the RITA and RA groups, respectively. During the first 4 years, RITA and RA were comparable in terms of mortality (hazard ratio [HR], 1.00; 95% confidence interval [CI], 0.56-1.78; P = .98). However, after 4 years RITA was associated with a significant reduction in late mortality (HR, 0.67; 95% CI, 0.48-0.95; P = .02). RITA was superior to RA when the experimental conduit was used to graft the left coronary system (HR, 0.69; 95% CI, 0.47-0.99; P = .04) but not the right coronary system (HR, 0.98; 95% CI, 0.59-1.62; P = .93).
In a highly selected low-risk group of patients, the use of the RITA as second arterial conduit instead of the RA was associated with better survival when used to graft the left but not the right coronary artery.
我们通过倾向评分匹配来确定，在冠状动脉旁路移植术中，当使用右侧内乳动脉（RITA）作为第二动脉移植物时，与使用桡动脉（RA）相比是否具有生存优势。
研究人群包括一组接受 RITA（n=764）或 RA（n=1990）作为第二动脉移植物的高度选择的低危患者。我们获得了 764 对匹配对，这些匹配对在所有预处理变量上均可比。使用按匹配对分层的时间分段 Cox 回归模型来研究治疗对晚期死亡率的影响。
平均随访 10.2±4.5 年后（最长 17.3 年），RITA 和 RA 组 5 年、10 年和 15 年的生存率分别为 96.4%±0.7%比 95.4%±0.7%、91.0%±1.1%比 89.1%±1.2%和 82.4%±1.9%比 77.2%±2.5%。在最初的 4 年内，RITA 和 RA 在死亡率方面相当（风险比 [HR]，1.00；95%置信区间 [CI]，0.56-1.78；P=1.00）。然而，4 年后，RITA 与晚期死亡率的显著降低相关（HR，0.67；95%CI，0.48-0.95；P=0.02）。当实验性移植物用于左冠状动脉系统时，RITA 优于 RA（HR，0.69；95%CI，0.47-0.99；P=0.04），但在右冠状动脉系统中并非如此（HR，0.98；95%CI，0.59-1.62；P=0.93）。
在一组高度选择的低危患者中，与使用 RA 相比，当 RITA 用作第二动脉移植物用于左冠状动脉而非右冠状动脉时，与生存改善相关。
