دورية أكاديمية
Multiarterial coronary grafting using the radial artery as a second arterial graft: how far does the survival benefit extend?
| العنوان: | Multiarterial coronary grafting using the radial artery as a second arterial graft: how far does the survival benefit extend? |
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| المؤلفون: | Qureshi SH; Department of Cardiac Surgery, Ottawa Heart Institute, Ottawa, ON, Canada., Boulemden A; Department of Cardiac Surgery, Nottingham City Hospital NHS Trust, Nottingham, UK., Darwin O; Department of Cardiac Surgery, University of Nottingham, School of Medicine, Queens Medical Centre, Nottingham, UK., Shanmuganathan S; Department of Cardiac Surgery, Nottingham City Hospital NHS Trust, Nottingham, UK., Szafranek A; Department of Cardiac Surgery, Nottingham City Hospital NHS Trust, Nottingham, UK., Naik S; Department of Cardiac Surgery, Nottingham City Hospital NHS Trust, Nottingham, UK. |
| المصدر: | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery [Eur J Cardiothorac Surg] 2021 Dec 27; Vol. 61 (1), pp. 216-224. |
| نوع المنشور: | Journal Article; Observational Study |
| اللغة: | English |
| بيانات الدورية: | Publisher: Oxford University Press Country of Publication: Germany NLM ID: 8804069 Publication Model: Print Cited Medium: Internet ISSN: 1873-734X (Electronic) Linking ISSN: 10107940 NLM ISO Abbreviation: Eur J Cardiothorac Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2012-: Oxford, England : Oxford University Press Original Publication: [Berlin] : Springer International ; [Secaucus, NJ, USA : Springer-Verlag New York Inc., distributor, c1987- |
| مواضيع طبية MeSH: | Coronary Artery Disease*/surgery , Mammary Arteries*/transplantation, Aged ; Humans ; Middle Aged ; Propensity Score ; Radial Artery/transplantation ; Retrospective Studies ; Treatment Outcome |
| مستخلص: | Objectives: Despite the 10-year results of the Arterial Revascularization Trial, the controversy regarding the survival benefit of multiarterial grafting (MAG) remains. Our goal was to present our long-term survival data in this propensity-matched observational study. Methods: A primary unmatched population of 4303 patients with first-time isolated coronary artery bypass grafts operated on between 2000 and 2018 were included. A total of 1187 post-matched patients were compared with matched controls. Multivariate logistic regression and Cox proportional hazard analyses were undertaken to assess the contribution of MAG and other covariates to the long-term survival of unmatched and propensity-matched populations. Results: MAG was associated with increased median survival in both the unmatched and the matched groups; difference: 962 and 1459 days, log-rank tests; P = 0.029 and 0.0004, respectively. MAG was associated with a reduced hazard of death in the unmatched as well as in the matched groups: hazard ratio [95% confidence interval (CI)]: 0.72 (0.62-0.83); P < 0.0001 and 0.75 (0.64-0.88); P ≤ 0.0001, respectively. In the matched group, the prosurvival factors were low logistic EuroSCORE, obesity, no intra-aortic balloon pump, an ejection fraction >30%, age 50-69 years, operation by an experienced surgeon, with and without diabetes, on-pump surgery and 3 distal anastomoses. In a cohort of 242 late-presenting patients with reinfarction or recurrent angina, both MAG and control populations were associated with reduced median survival; median (95% CI): MAG: 3026 (1138-3503); control: 3035 (2134-3991), log-rank P = 0.217 with superior patency of the left internal mammary artery but no difference between radial artery and saphenous vein grafts. Conclusions: Multiarterial revascularization, especially using the radial artery as a second arterial conduit, is associated with a significant survival benefit and a lack of in-hospital morbidity. (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Multiarterial grafting*; Radial artery*; Survival* |
| تواريخ الأحداث: | Date Created: 20210804 Date Completed: 20220405 Latest Revision: 20220429 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1093/ejcts/ezab308 |
| PMID: | 34347054 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1873-734X |
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| DOI: | 10.1093/ejcts/ezab308 |