title: Excellent long-term clinical outcome after coronary artery bypass surgery using three pedicled arterial grafts in patients with three-vessel disease.
abstract: BACKGROUND
  Long-term clinical outcome of complete arterial grafting in three-vessel disease is unknown.
  
  
  METHODS
  We studied 344 patients who underwent complete arterial revascularization using the internal thoracic arteries and the right gastroepiploic artery. Freedom from major adverse cardiac events (MACE) was evaluated by the Kaplan-Meier method, and homogeneity of outcome in strata of patients was assessed using Cox proportional hazards modeling.
  
  
  RESULTS
  Median follow-up of survivors was 9.3 years (range, 0.01 to 12.8 years). The 12-year freedom from MACE was 75.5%. For the composite of MACE, this was 86.9% for cardiovascular death, 93.3% for myocardial infarction, and 89.4% for reintervention. In patients aged older than 65 years, MACE occurred significantly more frequent, with a freedom from MACE of 65.8% compared with 82.6% in younger patients (hazard ratio, 3.4; 95% confidence interval, 2.1 to 5.6, p < 0.001).
  
  
  CONCLUSIONS
  Complete arterial revascularization using both pedicled internal thoracic arteries and the gastroepiploic artery in patients with three-vessel disease resulted in an excellent long-term clinical outcome, especially in patients aged younger than 65 years.
authors.affiliation: Thoraxcenter, Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Nic J G M
authors.initials: NJ
authors.lastname: Veeger
authors.forename: Gerald F
authors.initials: GF
authors.lastname: Panday
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Jan G
authors.initials: JG
authors.lastname: Grandjean
authors.forename: Jan
authors.initials: J
authors.lastname: van der Meer
authors.forename: Piet W
authors.initials: PW
authors.lastname: Boonstra
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D023903:Coronary Restenosis / Q000453:epidemiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D024405:Gastroepiploic Artery / Q000637:transplantation*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome