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Abstract：
OBJECTIVE: To compare the outcomes of left circumflex artery (LCx) revascularization using an internal thoracic artery (ITA) or radial artery (RA) as the second arterial graft.
METHODS: Patients who underwent primary isolated coronary artery bypass grafting with left anterior descending artery revascularization using an ITA and LCx revascularization using another bilateral ITA (BITA group) or an RA (ITA-RA group) were included. All-cause mortality (primary endpoint), cardiac death, major adverse cardiac events, in-hospital death, and deep sternal wound infection (secondary endpoints) were evaluated.
RESULTS: Among 790 patients (BITA, n = 548 (69%); ITA-RA, n = 242 (31%)), no significant difference in all-cause mortality between the groups was observed (hazard ratio (HR): 0.87; 95% confidence interval (CI): 0.67-1.12; p = 0.27) during follow-up (mean, 10 years). Multivariate analysis revealed that the BITA group exhibited significantly lower rates of long-term all-cause mortality (HR: 0.63; 95% CI: 0.48-0.84; p = 0.01). In the propensity-matched cohort (n = 480, 240 pairs), significantly fewer all-cause deaths occurred in the BITA group (HR: 0.66; 95% CI 0.47-0.93; p = 0.02). There were no significant differences in secondary outcomes.
CONCLUSIONS: When used as second grafts for LCx revascularization, ITA grafts may surpass RA grafts in reducing all-cause mortality 10 years postoperatively.
METHODS: Patients who underwent primary isolated coronary artery bypass grafting with left anterior descending artery revascularization using an ITA and LCx revascularization using another bilateral ITA (BITA group) or an RA (ITA-RA group) were included. All-cause mortality (primary endpoint), cardiac death, major adverse cardiac events, in-hospital death, and deep sternal wound infection (secondary endpoints) were evaluated.
RESULTS: Among 790 patients (BITA, n = 548 (69%); ITA-RA, n = 242 (31%)), no significant difference in all-cause mortality between the groups was observed (hazard ratio (HR): 0.87; 95% confidence interval (CI): 0.67-1.12; p = 0.27) during follow-up (mean, 10 years). Multivariate analysis revealed that the BITA group exhibited significantly lower rates of long-term all-cause mortality (HR: 0.63; 95% CI: 0.48-0.84; p = 0.01). In the propensity-matched cohort (n = 480, 240 pairs), significantly fewer all-cause deaths occurred in the BITA group (HR: 0.66; 95% CI 0.47-0.93; p = 0.02). There were no significant differences in secondary outcomes.
CONCLUSIONS: When used as second grafts for LCx revascularization, ITA grafts may surpass RA grafts in reducing all-cause mortality 10 years postoperatively.
摘要：
目的：比较使用胸廓内动脉（ITA）或桡动脉（RA）作为第二动脉移植的左回旋支（LCx）血运重建的结果。
方法：纳入使用ITA和使用另一个双侧ITA（BITA组）或RA（ITA-RA组）进行左前降支血运重建的原发性冠状动脉旁路移植术和LCx血运重建的患者。全因死亡率（主要终点），心脏死亡,主要不良心脏事件，在医院死亡,和深部胸骨伤口感染（次要终点）进行评估。
结果：在790例患者中（BITA，n=548（69%）；ITA-RA，n=242（31%）），在随访期间，两组之间的全因死亡率没有显着差异（风险比（HR）：0.87;95％置信区间（CI）：0.67-1.12;p=0.27）（平均值，10年）。多因素分析显示，BITA组的长期全因死亡率显著降低（HR：0.63；95%CI：0.48-0.84；p=0.01）。在倾向匹配队列中(n=480，240对)，BITA组的全因死亡发生率明显较少(HR:0.66;95%CI0.47-0.93;p=0.02).次要结果没有显着差异。
结论：当用作LCx血运重建的第二移植物时，在降低术后10年的全因死亡率方面，ITA移植物可能超过RA移植物。
方法：纳入使用ITA和使用另一个双侧ITA（BITA组）或RA（ITA-RA组）进行左前降支血运重建的原发性冠状动脉旁路移植术和LCx血运重建的患者。全因死亡率（主要终点），心脏死亡,主要不良心脏事件，在医院死亡,和深部胸骨伤口感染（次要终点）进行评估。
结果：在790例患者中（BITA，n=548（69%）；ITA-RA，n=242（31%）），在随访期间，两组之间的全因死亡率没有显着差异（风险比（HR）：0.87;95％置信区间（CI）：0.67-1.12;p=0.27）（平均值，10年）。多因素分析显示，BITA组的长期全因死亡率显著降低（HR：0.63；95%CI：0.48-0.84；p=0.01）。在倾向匹配队列中(n=480，240对)，BITA组的全因死亡发生率明显较少(HR:0.66;95%CI0.47-0.93;p=0.02).次要结果没有显着差异。
结论：当用作LCx血运重建的第二移植物时，在降低术后10年的全因死亡率方面，ITA移植物可能超过RA移植物。
