Prevalence and variability of internal mammary artery graft use in contemporary multivessel coronary artery bypass graft surgery: analysis of the Society of Thoracic Surgeons National Cardiac Database.
BACKGROUND
Use of an internal mammary artery (IMA) is a well-recognized, nationally endorsed quality indicator for evaluating the process of operative care for coronary artery bypass graft surgery. An objective assessment of the current status of IMA use has not been systematically performed.


RESULTS
This cross-sectional observational study analyzed data on 541 368 coronary artery bypass graft surgery procedures reported by 745 hospitals in the Society of Thoracic Surgeons National Cardiac Database from 2002 through 2005. We assessed the current status of IMA use, the association of hospital volume and IMA use, and disparities in IMA use by patient gender and race and by region of hospital location. Rates of using at least 1 IMA and bilateral IMA were 92.4% and 4.0%, with increasing trends over the years. Hospital volume was not significantly associated with IMA use. IMAs were used less frequently in women than men (for at least 1 IMA: odds ratio, 0.62; 95% confidence interval, 0.61 to 0.63; for bilateral IMA: odds ratio, 0.65; 95% confidence interval, 0.63 to 0.68) and less frequently in nonwhite patients than white patients (for at least 1 IMA: odds ratio, 0.84; 95% confidence interval, 0.81 to 0.87; for bilateral IMA: odds ratio, 0.79; 95% confidence interval, 0.75 to 0.83). There were significant differences in frequency of IMA use by hospital region.


CONCLUSIONS
Frequency of IMA use in coronary artery bypass graft surgery is increasing; however, many patients still do not receive the benefits of IMA grafts, and some hospitals have a very low IMA use rate. Hospital volume is not associated with IMA use in coronary artery bypass graft surgery. Analysis of this critical performance measure reveals significant gender and race disparities.
Tabata
Minoru
M
Department of Cardiovascular Surgery, Sakakibara Heart Institute, 3-16-1 Asahi-Cho, Fuchu-Shi, Tokyo 183-0003, Japan. mtabata@post.harvard.edu
Grab
Joshua D
JD
Khalpey
Zain
Z
Edwards
Fred H
FH
O'Brien
Sean M
SM
Cohn
Lawrence H
LH
Bolman
R Morton
RM
D017677:Age Distribution; D000368:Aged; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000601:surgery*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011787:Quality of Health Care; D044469:Racial Groups / Q000706:statistics & numerical data; D012044:Regression Analysis; D017678:Sex Distribution