title: Long-term results of sequential vein coronary artery bypass grafting compared with totally arterial myocardial revascularization: a propensity score-matched follow-up study†.
abstract: OBJECTIVE
  The aim of the study was to analyse the early and long-term outcomes of a consecutive series of patients who underwent sequential coronary artery bypass grafting (CABG) and to compare them with a matched population of totally arterial revascularized patients.
  
  
  METHODS
  From January 1994 to December 1996, 209 patients underwent total arterial myocardial revascularization at our institution [arterial (ART) group]. In the same period, 2097 patients underwent CABG with left internal thoracic artery on left anterior descending and great saphenous vein on the right and circumflex branches sequentially [sequential vein (SV) group]. The propensity score methodology was used to obtain risk-adjusted outcome comparisons between the two groups (209 vs 243 patients in the ART group and SV group, respectively).
  
  
  RESULTS
  In-hospital mortality was 1% in the ART group and 0.4% in the SV group (P = 0.86). Mean follow-up was 14 ± 4 years. Long-term survival was comparable among the two study groups [actuarial 5- and 15-year survival rates were 97 vs 93% and 82 vs 79% in the ART group and the SV group, respectively (P = 0.29)]. At follow-up, recurrence of angina (17 vs 18%; P = 0.99), acute myocardial infarction (MI) (3 vs 5%; P = 0.72) and repeated percutaneous coronary intervention (19 vs 21%; P = 0.69) were similar in the ART group compared with the SV group. In the Cox regression analysis, type of revascularization was not an independent predictor of any long-term outcomes (death or major adverse cardiac events). In asymptomatic patients, exercise stress test at follow-up was comparable between the two groups (P = 0.14).
  
  
  CONCLUSIONS
  Sequential vein CABG appears to have good early and long-term clinical outcomes. Also, early and long-term incidence of acute MI was not significantly higher in the SV group. However, further studies with a larger population are warranted in order to confirm the present results.
authors.affiliation: Department of Cardiovascular Disease 'E. Malan', Cardiac Surgery Unit, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy agaratti@tiscali.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Garatti
authors.affiliation: Department of Cardiovascular Disease 'E. Malan', Cardiac Surgery Unit, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy.
authors.forename: Serenella
authors.initials: S
authors.lastname: Castelvecchio
authors.affiliation: Department of Cardiovascular Disease 'E. Malan', Cardiac Surgery Unit, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Canziani
authors.affiliation: Department of Management and Engineering, University of Padua, Padua, Italy.
authors.forename: Livio
authors.initials: L
authors.lastname: Corain
authors.affiliation: Department of Cardiovascular Disease 'E. Malan', Cardiac Surgery Unit, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Generali
authors.affiliation: Department of Cardiovascular Disease 'E. Malan', Cardiac Surgery Unit, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Mossuto
authors.affiliation: Department of Cardiovascular Disease 'E. Malan', Cardiac Surgery Unit, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy.
authors.forename: Piervincenzo
authors.initials: P
authors.lastname: Gagliardotto
authors.affiliation: Department of Cardiovascular Disease 'E. Malan', Cardiac Surgery Unit, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Anastasia
authors.affiliation: Department of Management and Engineering, University of Padua, Padua, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Salmaso
authors.affiliation: Department of Cardiovascular Disease 'E. Malan', Cardiac Surgery Unit, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Giacomazzi
authors.affiliation: Department of Cardiovascular Disease 'E. Malan', Cardiac Surgery Unit, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Menicanti
mesh_terms: D000787:Angina Pectoris / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods* / Q000401:mortality; D057216:Propensity Score; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: CABG, arterial grafts; CABG, venous grafts; Ischaemic heart disease, angina; Outcomes