Three Arterial Grafts Improve Late Survival: A Meta-Analysis of Propensity-Matched Studies

Mario Fulvio Luigi Gaudino, Antonino Di Franco, John D. Puskas, Lucas B. Ohmes, Mario Iannaccone, Umberto Barbero, David Glineur, Juan B. Grau, Umberto Benedetto, Fabrizio D'Ascenzo, Fiorenzo Gaita, Leonard N. Girardi, David P. Taggart

Risultato della ricerca: Contributo in rivistaArticolo in rivista

57 Citazioni (Scopus)

Abstract

Background: Little evidence shows whether a third arterial graft provides superior outcomes compared with the use of 2 arterial grafts in patients undergoing coronary artery bypass grafting. A meta-analysis of all the propensity score-matched observational studies comparing the long-term outcomes of coronary artery bypass grafting with the use of 2-arterial versus 3-arterial grafts was performed. Methods: A literature search was conducted using MEDLINE, EMBASE, and Web of Science to identify relevant articles. Long-term mortality in the propensity score-matched populations was the primary end point. Secondary end points were in-hospital/30-day mortality for the propensity score-matched populations and long-term mortality for the unmatched populations. In the matched population, time-to-event outcome for long-term mortality was extracted as hazard ratios, along with their variance. Statistical pooling of survival (time-to-event) was performed according to a random effect model, computing risk estimates with 95% confidence intervals. Results: Eight propensity score-matched studies reporting on 10 287 matched patients (2-arterial graft: 5346; 3-arterial graft: 4941) were selected for final comparison. The mean follow-up time ranged from 37.2 to 196.8 months. The use of 3 arterial grafts was not statistically associated with early mortality (hazard ratio, 0.93; 95% confidence interval, 0.71-1.22; P=0.62). The use of 3 arterial grafts was associated with statistically significantly lower hazard for late death (hazard ratio, 0.8; 95% confidence interval, 0.75-0.87; P<0.001), irrespective of sex and diabetic mellitus status. This result was qualitatively similar in the unmatched population (hazard ratio, 0.57; 95% confidence interval, 0.33-0.98; P=0.04). Conclusions: The use of a third arterial conduit in patients with coronary artery bypass grafting is not associated with higher operative risk and is associated with superior long-term survival, irrespective of sex and diabetic mellitus status.
Lingua originaleEnglish
pagine (da-a)1036-1044
Numero di pagine9
RivistaCirculation
Volume135
DOI
Stato di pubblicazionePubblicato - 2017

Keywords

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • bilateral internal thoracic arteries
  • radial artery
  • total arterial revascularization

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