Hohri Yu, Zhao Yanling, Kurlansky Paul, Feng Iris, Yang Christine, Dardik Gabriel, Rajesh Kavya, Takayama Hiroo, Smith Craig R, Takeda Koji
Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, 177 Fort Washington Ave, New York, NY, 10019, USA.
Gen Thorac Cardiovasc Surg. 2025 Aug 20. doi: 10.1007/s11748-025-02184-5.
The effectiveness of bilateral internal mammary artery (BIMA) grafting during multivessel coronary artery bypass grafting (CABG) is uncertain in patients with mildly decreased renal function (glomerular filtration rate 60-89 ml/min/1.73 m). We compared outcomes of bilateral versus single IMA (SIMA) grafting in this population.
We analyzed 933 patients with mildly decreased renal function who underwent isolated primary CABG using BIMA (n = 454) or SIMA (n = 479) at our center. Patients receiving radial artery grafts or no IMA grafts were excluded. Inverse probability treatment weighting was used to create a well-balanced cohort. 6-year survival and the cumulative incidence of major adverse cardiac or cerebrovascular events (MACCE)-including death, stroke, myocardial infarction, revascularization, and rehospitalization-were assessed.
The median age of the entire cohort was 68.0 years (IQR 61.5-74.0). Median follow-up time was 4.63 years (IQR 4.46-4.82). In well-balanced cohort, BIMA group had a higher number of total distal anastomoses (P < 0.001), with similar rate of complete revascularization (P = 0.101). BIMA group had significantly higher 6-year survival compared to SIMA group (91.9% [87.7-96.3%]; 85.9% [81.7-90.2%]; P = 0.046), which was reconfirmed on multivariable Cox regression analysis (Hazard ratio: 0.505 [0.268-0.953], P = 0.035). MACCE incidence was significantly lower with BIMA (23.5% vs. 40.5%, P < 0.001).
Among patients with mildly decreased renal function, the BIMA group was associated with longer survival and lower major adverse cardiac or cerebrovascular events after multivessel CABG.
在肾功能轻度下降（肾小球滤过率60 - 89 ml/min/1.73 m²）的患者中，多支冠状动脉旁路移植术（CABG）期间双侧乳内动脉（BIMA）移植的有效性尚不确定。我们比较了该人群中双侧与单支乳内动脉（SIMA）移植的结局。
我们分析了933例肾功能轻度下降且在我们中心接受单纯初次CABG的患者，其中采用BIMA移植的有454例，采用SIMA移植的有479例。接受桡动脉移植或未接受乳内动脉移植的患者被排除。使用逆概率处理加权法创建一个均衡的队列。评估6年生存率以及主要不良心脏或脑血管事件（MACCE）的累积发生率，MACCE包括死亡、中风、心肌梗死、血管重建和再次住院。
整个队列的中位年龄为68.0岁（四分位间距61.5 - 74.0）。中位随访时间为4.63年（四分位间距4.46 - 4.82）。在均衡队列中，BIMA组的远端吻合总数更多（P < 0.001），完全血管重建率相似（P = 0.101）。与SIMA组相比，BIMA组的6年生存率显著更高（91.9% [87.7 - 96.3%]；85.9% [81.7 - 90.2%]；P = 0.046），多变量Cox回归分析再次证实了这一点（风险比：0.505 [0.268 - 0.953]，P = 0.035）。BIMA组的MACCE发生率显著更低（23.5% 对 40.5%，P < 0.001）。
在肾功能轻度下降的患者中，多支CABG术后BIMA组与更长的生存期和更低的主要不良心脏或脑血管事件相关。
