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Bilateral Versus Single Internal-Thoracic-Artery Grafts at 10 Years

Tuesday, February 5, 2019

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Source Name: The New England Journal of Medicine


David P. Taggart, Umberto Benedetto, Stephen Gerry, Douglas G. Altman, Alastair M. Gray, Belinda Lees, Mario Gaudino, Vipin Zamvar, Andrzej Bochenek, Brian Buxton, Cliff Choong, Stephen Clark, Marek Deja, Jatin Desai, Ragheb Hasan, Marek Jasinski, Peter O’Keefe, Fernando Moraes, John Pepper, Siven Seevanayagam, Catherine Sudarshan, Uday Trivedi, Stanislaw Wos, John Puskas, Marcus Flather, for the Arterial Revascularization Trial Investigators

The Arterial Revascularization Trial Investigators recently published the outcomes of coronary artery bypass grafting (CABG) using bliateral versus single internal thoracic artery (ITA) after 10 years. Patients were randomly assigned to CABG using the bliateral or single ITA. The primary outcome was death from any cause at 10-year follow-up. Secondary outcomes were the composite of death from any cause, myocardial infarction, or stroke, rate of repeat revascularization, and safety outcomes. At 10 years, death occurred in 644 patients (20.8%), with 315 deaths (20.3%) occurring in the bilateral ITA group versus 329 (21.2%) in the single-graft group (P=0.62). The number of secondary events was 385 (24.9%) in the bilateral ITA versus 425 (27.3%) in the single ITA group (hazard ratio, 0.90; 95% CI, 0.79 to 1.03). No significant differences were found between the two groups in the rate of death from any cause or the rate of the composite outcome of death, myocardial infarction, or stroke.  Further studies are needed to determine whether multiple arterial grafts can provide better outcomes than a single ITA graft.


As David Taggart mentioned to my surprise, the crossover BITA-LITA reached 100% for some of the surgeons. Considering the above, we should see what how the subgroup with BITA use (not ITT) fared in comparison to non-BITA

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