title: Coronary revascularization with the left internal thoracic artery and radial artery: comparison of short-term clinical evolution between elective and emergency surgery.
abstract: BACKGROUND
  Left internal thoracic artery-to left anterior descending artery grafting has become a fundamental part of coronary artery bypass grafting. This grafting has led to increased use of other arterial conduits, of which the radial artery is most popular. Whether radial grafting can be used in the emergency patient is not known. This study compares the short-term clinical evolution between elective vs emergency coronary artery bypass grafting surgery with left internal thoracic artery and radial artery.
  
  
  METHODS
  A retrospective study of 47 patients who underwent elective or emergency coronary artery bypass grafting from 1996 to 2003. All patients had coronary stenosis>70% in all target vessels. Only the left internal thoracic artery and radial artery were used as grafts. Patients were divided into elective group (23 patients) and emergency group (24 patients). Emergency criteria were unstable angina and/or critical coronary stenosis with high risk for acute myocardial infarction. Groups were similar for age and number of diseased vessels.
  
  
  RESULTS
  The mean number of left internal thoracic artery grafts per patient in the elective and emergency groups were respectively 1.17 and 1.38 (P=.17). The mean number of radial artery grafts per patient in the elective and emergency groups was respectively 2.26 and 2.08 (P=.48). The 30-day mortality was 0. There was no postoperative cardiogenic shock. The elective group had 1 acute myocardial infarction (4.4%) postoperatively, and emergency group had 5 (20.8%). A nonsignificant trend towards acute myocardial infarction was noted in the emergency group (P=.18). Intensive care unit and postoperative stay were similar in both groups.
  
  
  CONCLUSIONS
  Coronary artery bypass grafting using left internal thoracic artery and radial artery accomplishing complete revascularization can be performed in emergency patients with results similar to those for elective patients.
authors.affiliation: Heart Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rocha-E-Silva
authors.forename: Antônio
authors.initials: A
authors.lastname: de Pádua Mansur
authors.forename: José
authors.initials: J
authors.lastname: Fabri Junior
authors.forename: Rogério Bicudo
authors.initials: RB
authors.lastname: Ramos
authors.forename: Carlos Edson Campos
authors.initials: CE
authors.lastname: Cunha Filho
authors.forename: Luis Alberto Oliveira
authors.initials: LA
authors.lastname: Dallan
authors.forename: Sérgio Almeida
authors.initials: SA
authors.lastname: de Oliveira
mesh_terms: D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000601:surgery*; D017558:Elective Surgical Procedures; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000637:transplantation*; D012189:Retrospective Studies; D013895:Thoracic Arteries / Q000637:transplantation*; D016896:Treatment Outcome