title: Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly: Long-Term Survival Benefit.
abstract: BACKGROUND
  Extensive evidence documents a survival benefit for bilateral internal mammary artery (BIMA) grafting compared with single internal mammary artery (SIMA) grafting for patients with advanced coronary artery disease. However, controversy continues to exist regarding the incremental benefit of broadly applied BIMA grafting in elderly patients.
  
  
  METHODS
  Retrospective analysis was conducted of 4,503 consecutive isolated coronary artery bypass grafting operations (SIMA, n = 2,340 and BIMA, n = 2,163) performed from 1972 to 1994. Multivariate analysis was used to created propensity score-matched groups of SIMA (n = 1,063) and BIMA (n = 1,063) to compare patients 65 years of age and older, and 70 years of age and older (n = 612), with similar baseline characteristics. Survival status was obtained by periodic follow-up, query of the US National Death Index, and other Internet searches, and was 99.6% complete.
  
  
  RESULTS
  The propensity score-matched groups experienced similar perioperative mortality and morbidity. Survival benefits were found for BIMA versus SIMA grafting across both age categories. Actuarial curves after 23,593 patient-years of follow-up (mean BIMA = 11.7 years; 6 weeks to 33.1 years; mean SIMA = 10.5 years; 6 weeks to 30.7 years) demonstrated improved long-term survival for BIMA versus SIMA patients at 12 years (51.0 ± 1.5% versus 39.0 ± 1.5%) and at 24 years (3.5 ± 0.7% versus 4.5 ± 0.7%; p < 0.001). Similarly, in matched groups of patients age 70 and older, overall survival was also enhanced with BIMA grafting (p = 0.005).
  
  
  CONCLUSIONS
  Advanced age should not be a contraindication for BIMA grafting. Long-term follow-up clearly demonstrates that BIMA grafting when broadly applied in elderly patients results in improved long-term survival over SIMA grafting.
authors.affiliation: Florida Heart Research Institute, Miami, Florida; Columbia University Medical Center, New York, New York. Electronic address: pk2245@cumc.columbia.edu.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Kurlansky
authors.affiliation: Florida Heart Research Institute, Miami, Florida.
authors.forename: Ernest A
authors.initials: EA
authors.lastname: Traad
authors.affiliation: Florida Heart Research Institute, Miami, Florida.
authors.forename: Malcolm J
authors.initials: MJ
authors.lastname: Dorman
authors.affiliation: Florida Heart Research Institute, Miami, Florida.
authors.forename: David L
authors.initials: DL
authors.lastname: Galbut
authors.affiliation: Florida Heart Research Institute, Miami, Florida.
authors.forename: George
authors.initials: G
authors.lastname: Ebra
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors