Second Arterial Versus Venous Conduits for Multivessel Coronary Artery Bypass Surgery in California
Main finding · All-cause mortalityResult — go to the resultHazard ratio 0.79 95% CI 0.72–0.87Authors' conclusion
Second arterial conduit use in California is low and declining, but arterial grafts were associated with significantly lower mortality and fewer cardiovascular events. A right internal thoracic artery graft offered no benefit over that of a radial artery, but did increase risk of sternal wound infection.
Study context
- Population
- Patients undergoing primary, isolated multivessel CABG with the left internal thoracic artery in California, 2006–20115,813 matched sets
- Participants
- 5,866 vs 53,566
- Exposure
- Second arterial conduit vs venous conduit in multivessel CABG
- Second arterial conduitn = 5,866
- Venous conduitn = 53,566reference
- Outcome
- All-cause mortality
- Follow-up
- 7 years
Methodological detailspropensity-score matched, state clinical registry, 126 nonfederal hospitals in California
- Propensity-score matched
- State clinical registry
- 126 nonfederal hospitals in California
Main finding
As reported in the abstract
Hazard ratio
0.79
95% CI 0.72–0.87
Second arterial conduit vs Venous conduit
HR 0.79 (95% CI 0.72–0.87)
Observational data: associations, not effects.
Further findings
| Outcome | Right internal thoracic artery | Radial artery | HR (95% CI) | |
|---|---|---|---|---|
| MI | 0.78 (0.70–0.87) | |||
| Repeat revascularization | 0.82 (0.76–0.88) | |||
| Mortality, right internal thoracic artery vs radial artery (subgroup) · 7 years | 10.3% | 10.7% | 1.10 (0.89–1.37) | |
| 0.512Hazard ratio (log scale) |
- Mortality, right internal thoracic artery vs radial artery (subgroup): propensity-score matched subgroup: right internal thoracic artery n=1576, radial artery n=4290
Second arterial conduit use over time · 2006 to 2011
- Use decreased from 10.7% in 2006 to 9.1% in 2011
- P < 0.0001
Mortality, right internal thoracic artery vs radial artery (subgroup) · 7 years
- Similar individual risks of CV events
Safety
| Outcome | Risk difference (95% CI) | |
|---|---|---|
| Sternal wound infection, right internal thoracic artery vs radial artery (subgroup) | 1.07% (0.15–2.07) | |
| −10123Difference (linear scale) |
Original publication
Second Arterial Versus Venous Conduits for Multivessel Coronary Artery Bypass Surgery in California. Circulation. Published 14 December 2017. doi:10.
Summarised from the published abstract; every number is checked against it