Safety of internal thoracic artery use in patients with prior mediastinal radiation undergoing coronary artery bypass grafting: a Maryland statewide propensity-matched analysis
Authors' conclusion
In this large retrospective cohort, prior mediastinal radiation was not associated with an increased risk of perioperative adverse events in patients undergoing CABG receiving ITA grafts. These findings demonstrate no evidence of safety concerns with the use of ITA grafting in patients with prior radiation and challenge the practice of excluding these patients from arterial revascularisation strategies.
Study context
- Population
- Patients who underwent coronary artery bypass grafting (CABG) with internal thoracic artery (ITA) use between 1 July 2011 and 31 March 2023, Maryland Cardiac Surgery Quality Initiative (MCSQI) database294 (1%) had a history of mediastinal radiation
- Participants
- 29,206 patients
- Exposure
- Patients with and without prior mediastinal radiation undergoing CABG with ITA grafting
- Prior mediastinal radiationn = 294
- Outcome
- Composite of:
- Operative mortality
- Deep sternal wound infection (DSWI)
Methodological detailspropensity-matched (1:10), nearest neighbour method
- Propensity-matched (1:10)
- Nearest neighbour method
Main finding
As reported in the abstract
P = 0.53
Observational data: associations, not effects.
Secondary outcomes
Baseline characteristics (before matching)
Age, median (IQR), years Prior mediastinal radiation 70 (60-75) · No prior mediastinal radiation 66 (59-73)
Female
Chronic lung disease
- Baseline characteristics (before matching): age p<0.001
- Baseline characteristics (before matching): female p<0.001
- Baseline characteristics (before matching): chronic lung disease p<0.001
Secondary outcomes (other infectious complications, major morbidities, postoperative hospital length of stay, 30-day readmission)
- No significant differences after propensity matching
Original publication
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