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Takagi H, et al. – A 12–year–ago landmark meta–analysis of bilateral versus single internal thoracic artery (bilateral ITA [BITA] versus single ITA [SITA]) coronary artery bypass grafting for long–term survival included 7 observational studies (only 3 of which reported adjusted hazard ratios [HRs]) enrolling approximately 16,000 patients. Updating the previous meta–analysis to determine whether BITA grafting reduces long–term mortality over SITA grafting, the authors exclusively abstracted (then combined in a meta–analysis) adjusted (not unadjusted) HRs from observational studies. Based on an updated meta–analysis of exclusive adjusted HRs from 20 observational studies enrolling >70,000 patients, BITA grafting appears to significantly reduce long–term mortality. As the proportion of men increases, BITA grafting is more beneficial in reducing the mortality.
Methods
MEDLINE and EMBASE were searched through September 2013.
Eligible studies were observational studies of BITA versus SITA grafting and reporting adjusted HRs for long-term (≥4-year) mortality as an outcome.
Meta-regression analyses were performed to determine whether the effects of BITA grafting were modulated by the pre-specified factors.
Results
Twenty observational studies enrolling 70,897 patients were identified and included.
A pooled analysis suggested a significant reduction in long-term mortality with BITA relative to SITA grafting (HR, 0.80; 95% confidence interval, 0.77 to 0.84).
When data from 6 pedicled and 6 skeletonized ITA studies were separately pooled, BITA grafting was associates with a statistically significant 26% and 16% reduction in mortality relative to SITA grafting, respectively (P for subgroup differences = .04).
A meta-regression coefficient was significantly negative for proportion of men (–0.00960; -0.01806 to -0.00114).
