title: The effect of internal thoracic artery grafts on long-term clinical outcomes after coronary bypass surgery.
abstract: OBJECTIVE
  We sought to compare long-term outcomes after coronary bypass surgery with and without an internal thoracic artery graft.
  
  
  METHODS
  We analyzed clinical outcomes over a median follow-up of 6.7 years among 3,087 patients who received coronary bypass surgery as participants in one of 8 clinical trials comparing surgical intervention with angioplasty. We used 2 statistical methods (covariate adjustment and propensity score matching) to adjust for the nonrandomized selection of internal thoracic artery grafts.
  
  
  RESULTS
  Internal thoracic artery grafting was associated with lower mortality, with hazard ratios of 0.77 (confidence interval, 0.62-0.97; P = .02) for covariate adjustment and 0.77 (confidence interval, 0.57-1.05; P = .10) for propensity score matching. The composite end point of death or myocardial infarction was reduced to a similar extent, with hazard ratios of 0.83 (confidence interval, 0.69-1.00; P = .05) for covariate adjustment to 0.78 (confidence interval, 0.61-1.00; P = .05) for propensity score matching. There was a trend toward less angina at 1 year, with odds ratios of 0.81 (confidence interval, 0.61-1.09; P = .16) in the covariate-adjusted model and 0.81 (confidence interval, 0.55-1.19; P = .28) in the propensity score-adjusted model.
  
  
  CONCLUSIONS
  Use of an internal thoracic artery graft during coronary bypass surgery seems to improve long-term clinical outcomes.
authors.affiliation: Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA 94305-5405, USA. hlatky@stanford.edu
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hlatky
authors.forename: David
authors.initials: D
authors.lastname: Shilane
authors.forename: Derek B
authors.initials: DB
authors.lastname: Boothroyd
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Maria M
authors.initials: MM
authors.lastname: Brooks
authors.forename: Didier
authors.initials: D
authors.lastname: Carrié
authors.forename: Tim C
authors.initials: TC
authors.lastname: Clayton
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
authors.forename: Marcus
authors.initials: M
authors.lastname: Flather
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.forename: Whady A
authors.initials: WA
authors.lastname: Hueb
authors.forename: Jan
authors.initials: J
authors.lastname: Kahler
authors.forename: Neuza
authors.initials: N
authors.lastname: Lopes
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Pocock
authors.forename: Alfredo
authors.initials: A
authors.lastname: Rodriguez
authors.forename: Patrick
authors.initials: P
authors.lastname: Serruys
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sigwart
authors.forename: Rodney H
authors.initials: RH
authors.lastname: Stables
mesh_terms: D000787:Angina Pectoris / Q000209:etiology / Q000517:prevention & control; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D019317:Evidence-Based Medicine; D006801:Humans; D016015:Logistic Models; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D016017:Odds Ratio; D057216:Propensity Score; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome