Population Health Research Institute and Hamilton Health Sciences, Hamilton, Ontario, Canada.
Population Health Research Institute and Hamilton Health Sciences, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Ann Thorac Surg. 2024 Dec;118(6):1245-1253. doi: 10.1016/j.athoracsur.2024.07.044. Epub 2024 Sep 7.
Recent evidence has suggested use of the right internal mammary artery (RIMA) is associated with worse clinical outcomes in patients undergoing coronary artery bypass grafting (CABG) surgery. Therefore, we compared the clinical consequences of secondary conduit selection (RIMA vs radial artery vs saphenous vein) after CABG.
A post-hoc analysis of the CABG Off or On Pump Revascularization Study, involving 3913 patients from 79 centers in 19 countries who underwent CABG surgery and received arterial grafting with at least 2 grafts. Outcomes of interest were all-cause mortality, myocardial infarction, stroke, and revascularization.
A total of 3913 patients received veins (3210; 68%), radial arteries (549; 12%), or RIMAs (154; 3%) to supplement left internal mammary artery to left anterior descending artery grafts. The risk of all-cause mortality was reduced in patients who received secondary radial arteries compared with veins (weighted hazard ratio [HR], 0.79; 95% CI, 0.64-0.98) and increased in patients who received RIMA compared with veins (weighted HR, 1.37; 95% CI, 1.13-1.68) after 4.8 years of follow-up. Multiple and single arterial grafting had a similar mortality risk (weighted HR, 0.87; 95% CI, 0.73-1.03).
Supplementing left internal mammary artery to left anterior descending artery grafting using radial arteries led to better clinical outcomes than veins, and too few RIMA were available to draw definitive conclusions. A randomized trial is needed to clarify the role of the RIMA in multiple arterial grafting CABG surgery.
最近的证据表明，在接受冠状动脉旁路移植术（CABG）的患者中，使用右内乳动脉（RIMA）与更差的临床结局相关。因此，我们比较了 CABG 后二次选择（RIMA 与桡动脉与隐静脉）的临床后果。
这是一项 CABG 离线或在线再血管化研究的事后分析，涉及来自 19 个国家 79 个中心的 3913 名患者，这些患者接受了 CABG 手术，至少使用 2 个移植物进行了动脉移植。感兴趣的结果是全因死亡率、心肌梗死、卒中和血运重建。
共有 3913 名患者接受静脉（3210 例；68%）、桡动脉（549 例；12%）或 RIMA（154 例；3%）来补充左内乳动脉至前降支动脉的移植物。与静脉相比，接受二级桡动脉的患者全因死亡率降低（加权风险比[HR]，0.79；95%置信区间，0.64-0.98），而与静脉相比，接受 RIMA 的患者增加（加权 HR，1.37；95%置信区间，1.13-1.68）在 4.8 年的随访后。多发性和单发性动脉移植的死亡率风险相似（加权 HR，0.87；95%置信区间，0.73-1.03）。
使用桡动脉补充左内乳动脉至前降支动脉的移植物导致比静脉更好的临床结局，而 RIMA 的数量太少，无法得出明确的结论。需要进行随机试验来阐明 RIMA 在多发性动脉移植 CABG 手术中的作用。
