From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.).
N Engl J Med. 2019 Jan 31;380(5):437-446. doi: 10.1056/NEJMoa1808783.
Multiple arterial grafts may result in longer survival than single arterial grafts after coronary-artery bypass grafting (CABG) surgery. We evaluated the use of bilateral internal-thoracic-artery grafts for CABG.
We randomly assigned patients scheduled for CABG to undergo bilateral or single internal-thoracic-artery grafting. Additional arterial or vein grafts were used as indicated. The primary outcome was death from any cause at 10 years. The composite of death from any cause, myocardial infarction, or stroke was a secondary outcome.
A total of 1548 patients were randomly assigned to undergo bilateral internal-thoracic-artery grafting (the bilateral-graft group) and 1554 to undergo single internal-thoracic-artery grafting (the single-graft group). In the bilateral-graft group, 13.9% of the patients received only a single internal-thoracic-artery graft, and in the single-graft group, 21.8% of the patients also received a radial-artery graft. Vital status was not known for 2.3% of the patients at 10 years. In the intention-to-treat analysis at 10 years, there were 315 deaths (20.3% of the patients) in the bilateral-graft group and 329 deaths (21.2%) in the single-graft group (hazard ratio, 0.96; 95% confidence interval [CI], 0.82 to 1.12; P=0.62). Regarding the composite outcome of death, myocardial infarction, or stroke, there were 385 patients (24.9%) with an event in the bilateral-graft group and 425 patients (27.3%) with an event in the single-graft group (hazard ratio, 0.90; 95% CI, 0.79 to 1.03).
Among patients who were scheduled for CABG and had been randomly assigned to undergo bilateral or single internal-thoracic-artery grafting, there was no significant between-group difference in the rate of death from any cause at 10 years in the intention-to-treat analysis. Further studies are needed to determine whether multiple arterial grafts provide better outcomes than a single internal-thoracic-artery graft. (Funded by the British Heath Foundation and others; Current Controlled Trials number, ISRCTN46552265 .).
在冠状动脉旁路移植术（CABG）后，使用多支动脉移植物可能比单支动脉移植物的存活率更高。我们评估了双侧内乳动脉用于 CABG 的效果。
我们将接受 CABG 的患者随机分为双侧或单侧内乳动脉移植组。根据需要使用其他动脉或静脉移植物。主要结局是 10 年内任何原因导致的死亡。次要结局是任何原因导致的死亡、心肌梗死或中风的复合结局。
共有 1548 名患者被随机分为双侧内乳动脉移植组（双侧移植组）和 1554 名患者分为单侧内乳动脉移植组（单侧移植组）。在双侧移植组中，有 13.9%的患者仅接受了单支内乳动脉移植，而在单侧移植组中，有 21.8%的患者还接受了桡动脉移植。10 年后，有 2.3%的患者无法确定其生存状况。在 10 年的意向治疗分析中，双侧移植组有 315 例死亡（患者的 20.3%），单侧移植组有 329 例死亡（患者的 21.2%）（风险比，0.96；95%置信区间[CI]，0.82 至 1.12；P=0.62）。关于死亡、心肌梗死或中风的复合结局，在双侧移植组中有 385 例（24.9%）患者发生事件，在单侧移植组中有 425 例（27.3%）患者发生事件（风险比，0.90；95%CI，0.79 至 1.03）。
在接受 CABG 并被随机分为双侧或单侧内乳动脉移植组的患者中，意向治疗分析中 10 年时全因死亡率无显著组间差异。需要进一步的研究来确定多支动脉移植物是否比单支内乳动脉移植物提供更好的结局。（由英国卫生基金会和其他机构资助；当前对照试验编号，ISRCTN46552265）。
