背景:胸廓内动脉(ITA)是冠状动脉旁路移植术最重要的导管。最近的证据表明,骨骼化的ITA收获产生的长期结果不如带蒂收获。目的是调查ITA收获方法对10年死亡率和主要不良心血管事件的影响。
结果:在这项观察性队列研究中,我们从SWEDEHEART(根据推荐的治疗方法评估的增强和发展心脏病循证护理的瑞典网络系统)登记中确定了所有患者,这些患者在2012年至2021年期间在卡罗林斯卡大学医院接受了至少1次ITA的单独冠状动脉旁路移植术.主要结果是全因死亡率,次要结果是心肌梗死的组合,重复血运重建,心力衰竭,和中风。使用国家健康数据寄存器确定结果,并使用加权灵活参数生存模型在骨骼化和带蒂组之间进行比较。在3267名患者中,1657(51%)进行了带蒂的ITA收获,1610(49%)进行了骨骼化的ITA收获。病人的平均年龄是66岁,15%是女性。带蒂与骨骼化ITA组的加权全因死亡率发生率分别为2.6%(95CI,2.2%-3.0%)和2.6%(95%CI,2.2%-3.1%),分别(危险比(HR),1.01[95%CI,0.81-1.27])。加权主要不良心血管事件发生率分别为7.8%(95%CI,7.1%-8.6%)和7.5%(95%CI,6.7%-8.4%),分别(HR,0.94[95%CI,0.82-1.08])。
结论:我们发现两种ITA采集方法在全因死亡率或主要不良心血管事件发生率方面没有显著差异。
BACKGROUND: The internal thoracic artery (ITA) is the most important conduit for coronary artery bypass grafting. Recent evidence suggests that skeletonized ITA harvesting yields long-term outcomes inferior to those of pedicled harvesting. The aim was to investigate the impact of the ITA harvesting method on 10-year mortality and major adverse cardiovascular events.
RESULTS: In this observational cohort study, we identified all patients from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) register who underwent isolated coronary artery bypass grafting using at least 1 ITA at Karolinska University Hospital from 2012 to 2021. The main outcome was all-cause mortality, and the secondary outcomes were a combination of myocardial infarction, repeat revascularization, heart failure, and stroke. Outcomes were ascertained using national health data registers and compared between the skeletonized and pedicled groups using weighted flexible parametric survival models. Among 3267 patients, 1657 (51%) underwent pedicled ITA harvesting and 1610 (49%) underwent skeletonized ITA harvesting. The patients\' mean age was 66 years, and 15% were women. The weighted all-cause mortality incidence rate in the pedicled versus skeletonized ITA group was 2.6% (95CI, 2.2%-3.0%) versus 2.6% (95% CI, 2.2%-3.1%), respectively (hazard ratio (HR), 1.01 [95% CI, 0.81-1.27]). The weighted major adverse cardiovascular events incidence rate was 7.8% (95% CI, 7.1%-8.6%) versus 7.5% (95% CI, 6.7%-8.4%), respectively (HR, 0.94 [95% CI, 0.82-1.08]).
CONCLUSIONS: We found no significant differences in all-cause mortality or major adverse cardiovascular events rates between the 2 ITA harvesting methods.