title: Is the second internal thoracic artery better than the radial artery in total arterial off-pump coronary artery bypass grafting? A propensity score-matched follow-up study.
abstract: OBJECTIVE
  The aim of our study was to evaluate the long-term outcome of patients exclusively undergoing total arterial revascularization off-pump coronary artery bypass grafting and to compare the performance of the radial artery and the right internal thoracic artery as a second conduit.
  
  
  METHODS
  We studied a consecutive series of 1700 patients undergoing off-pump coronary artery bypass grafting, receiving a radial artery or right internal thoracic artery as a second graft for total arterial revascularization, between 2003 and 2010. A total of 1447 patients (85.11%) received bilateral internal thoracic artery grafting, and 253 patients (14.89%) received left internal thoracic artery and radial artery grafting. A propensity score-matched analysis was performed to compare the 2 groups, bilateral internal thoracic artery and left internal thoracic artery and radial artery, relative to overall survival, morbidity, and combined end points event-free survival. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were estimated by Cox regression.
  
  
  RESULTS
  In the full unmatched patient population, the postoperative survival (HR, 0.59; 95% CI, 0.38-0.92; P = .021), incidence of reintervention/readmission (HR, 0.42; 95% CI, 0.28-0.61; P < .001), and combined end points (HR, 0.47; 95% CI, 0.35-0.63; P < .001) were significantly better in the bilateral internal thoracic artery group. In the propensity score-matched patient population, the incidence of reintervention/readmission (HR, 0.40; 95% CI, 0.18-0.88; P = .02) and combined end points (HR, 0.54; 95% CI, 0.32-0.92; P = .02) were significantly better in the bilateral internal thoracic artery group compared with the left internal thoracic artery-radial artery group.
  
  
  CONCLUSIONS
  The results of our study provide evidence for the superiority of the right internal thoracic artery graft compared with the radial artery as a second conduit in total arterial revascularization off-pump coronary artery bypass grafting.
authors.affiliation: Cardiac Surgery Service, Instituto Cardiovascular de Buenos Aires, Argentina. Electronic address: Navia.daniel@gmail.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Navia
authors.affiliation: Cardiac Surgery Service, Instituto Cardiovascular de Buenos Aires, Argentina.
authors.forename: Mariano
authors.initials: M
authors.lastname: Vrancic
authors.affiliation: Cardiac Surgery Service, Instituto Cardiovascular de Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Piccinini
authors.affiliation: Cardiac Surgery Service, Instituto Cardiovascular de Buenos Aires, Argentina.
authors.forename: Mariano
authors.initials: M
authors.lastname: Camporrotondo
authors.affiliation: Cardiac Surgery Service, Instituto Cardiovascular de Buenos Aires, Argentina.
authors.forename: Jorge
authors.initials: J
authors.lastname: Thierer
authors.affiliation: Cardiac Surgery Service, Instituto Cardiovascular de Buenos Aires, Argentina.
authors.forename: Christian
authors.initials: C
authors.lastname: Gil
authors.affiliation: Cardiac Surgery Service, Instituto Cardiovascular de Buenos Aires, Argentina.
authors.forename: Mariano
authors.initials: M
authors.lastname: Benzadon
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000401:mortality; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D011183:Postoperative Complications / Q000601:surgery; D057216:Propensity Score; D016016:Proportional Hazards Models; D017534:Radial Artery / Q000637:transplantation*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: 23; BITA; CABG; CI; European System for Cardiac Operative Risk Evaluation; HR; IQR; ITA; LAD; LITA; OPCAB; OR; RA; RITA; SVG; TAR; bilateral internal thoracic artery; confidence interval; coronary artery bypass grafting; euroSCORE; hazard ratio; internal thoracic artery; interquartile range; left anterior descending; left internal thoracic artery; odds ratio; off-pump coronary artery bypass; radial artery; right internal thoracic artery; saphenous vein graft; total arterial revascularization