title: Second internal thoracic artery versus radial artery in coronary artery bypass grafting: a long-term, propensity score-matched follow-up study.
abstract: BACKGROUND
  The best second arterial conduit for multiple arterial revascularization (MAR) is still a matter of debate. Previous studies on the benefit of either using the radial artery (RA) or the right internal thoracic artery (RITA) in coronary artery bypass grafting are not conclusive. The aim of our study was to compare the perioperative and long-term outcome of either RA or RITA grafts as second conduits for MAR.
  
  
  RESULTS
  A consecutive series of 1001 patients undergoing first nonemergent coronary artery bypass grafting receiving either RA or RITA as second graft for MAR between 2001 and 2010 were studied. There were 277 patients receiving a RITA and 724 patients receiving a RA in addition to a left internal thoracic artery (LITA). Concomitant saphenous vein grafts (SVG) were grafted in addition as necessary. Propensity score-matched analysis was performed to compare the 2 groups, bilateral ITA±SVG (BITA±SVG group) and the LITA+RA±SVG group relative to overall survival and major adverse cardiac and cerebrovascular events-free survival. Hazard ratios and their 95% confidence intervals were estimated by COX regression stratified on matched pairs. The incidence of perioperative major adverse cardiac and cerebrovascular events was significantly lower in the BITA±SVG group (1.4% versus 7.6%, P<0.001). Overall survival (hazard ratio 0.23; 95% confidence interval 0.066-0.81; P=0.022) and major adverse cardiac and cerebrovascular events-free survival (hazard ratio 0.18; 95% confidence interval 0.08-0.42; P<0.001) were significantly better in the BITA±SVG group compared to the LITA+RA±SVG group.
  
  
  CONCLUSIONS
  The results of our study provide strong evidence for the superiority of a RITA graft compared to RA as a second conduit in MAR.
authors: Department of Cardiac Surgery, Innsbruck Medical University, Austria. elfriede.ruttmann@i-med.ac.at
authors: Elfriede
authors: E
authors: Ruttmann
authors: Nikolaus
authors: N
authors: Fischler
authors: Adel
authors: A
authors: Sakic
authors: Orest
authors: O
authors: Chevtchik
authors: Hannes
authors: H
authors: Alber
authors: Roland
authors: R
authors: Schistek
authors: Hanno
authors: H
authors: Ulmer
authors: Michael
authors: M
authors: Grimm
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D057216:Propensity Score; D011446:Prospective Studies; D017534:Radial Artery / Q000637:transplantation*; D016896:Treatment Outcome