The impact of a second arterial graft on 5-year outcomes after coronary artery bypass grafting in the Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery Trial and Registry

Catalina A. Parasca, Stuart J. Head, Friedrich W. Mohr, Michael J. Mack, Marie Claude Morice, David R. Holmes, Ted E. Feldman, Antonio Colombo, Keith D. Dawkins, Patrick W. Serruys, Arie Pieter Kappetein

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective Despite various evidence supporting the advantages of multiple arterial grafting, inconsistencies in use of the procedure have resulted in high variability in the acceptance and practice of arterial grafting. The purpose of this study was to assess the effects of an arterial versus venous second grafts on outcomes at 5-year follow-up in the coronary artery bypass grafting population from the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial. Methods Patients (n = 1419) with an arterial graft to the left anterior descending artery and ≥1 other graft were included and divided according to the second graft's type: 2nd-graft-arterial group (n = 456) and 2nd-graft-venous group (n = 963). Five-year outcomes were compared between subgroups. Event rates were estimated with Kaplan-Meier analyses. Propensity-score matching was used, to control for selection bias due to nonrandom group assignment in a 1:1 manner, resulting in 432 pairs with balanced baseline characteristics. Results In unmatched groups, the 2nd-graft-arterial group had significantly lower rates of death (8.9% vs 13.1%; P =.02), and composite safety endpoint of death/stroke/myocardial infarction (13.3% vs 18.7%; P =.02), compared with the 2nd-graft-venous group. The rate of major adverse cardiac or cerebrovascular events was similar between groups (22.9% vs 25.5%; P =.30), because it includes the rate of repeat revascularization (12.6% in the 2nd-graft-arterial group vs 9.6% in the 2nd-graft-venous group; P =.10). After propensity-score matching, no statistically significant differences were found between groups. Conclusions This study reveals comparable 5-year outcomes with arterial and venous conduits as second grafts after an arterial graft anastomosed to the left anterior descending artery. This study demonstrates the multi-institutional variation in patient selection and operator technique with regard to arterial revascularization, although extended follow-up beyond 5 years is required to estimate its impact on long-term outcomes. Clinical Trial Number NCT00114972

Original languageEnglish
Pages (from-to)597-606e2
JournalJournal of Thoracic and Cardiovascular Surgery
Volume150
Issue number3
DOIs
Publication statusPublished - Sep 1 2015

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Percutaneous Coronary Intervention
Coronary Artery Bypass
Thoracic Surgery
Registries
Transplants
Propensity Score
Arteries
Selection Bias
Kaplan-Meier Estimate
Patient Selection
Stroke
Myocardial Infarction
Clinical Trials
Safety

Keywords

  • arterial graft
  • coronary artery bypass
  • SYNTAX
  • venous graft

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

The impact of a second arterial graft on 5-year outcomes after coronary artery bypass grafting in the Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery Trial and Registry. / Parasca, Catalina A.; Head, Stuart J.; Mohr, Friedrich W.; Mack, Michael J.; Morice, Marie Claude; Holmes, David R.; Feldman, Ted E.; Colombo, Antonio; Dawkins, Keith D.; Serruys, Patrick W.; Kappetein, Arie Pieter.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 150, No. 3, 01.09.2015, p. 597-606e2.

Research output: Contribution to journalArticle

Parasca, Catalina A. ; Head, Stuart J. ; Mohr, Friedrich W. ; Mack, Michael J. ; Morice, Marie Claude ; Holmes, David R. ; Feldman, Ted E. ; Colombo, Antonio ; Dawkins, Keith D. ; Serruys, Patrick W. ; Kappetein, Arie Pieter. / The impact of a second arterial graft on 5-year outcomes after coronary artery bypass grafting in the Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery Trial and Registry. In: Journal of Thoracic and Cardiovascular Surgery. 2015 ; Vol. 150, No. 3. pp. 597-606e2.
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abstract = "Objective Despite various evidence supporting the advantages of multiple arterial grafting, inconsistencies in use of the procedure have resulted in high variability in the acceptance and practice of arterial grafting. The purpose of this study was to assess the effects of an arterial versus venous second grafts on outcomes at 5-year follow-up in the coronary artery bypass grafting population from the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial. Methods Patients (n = 1419) with an arterial graft to the left anterior descending artery and ≥1 other graft were included and divided according to the second graft's type: 2nd-graft-arterial group (n = 456) and 2nd-graft-venous group (n = 963). Five-year outcomes were compared between subgroups. Event rates were estimated with Kaplan-Meier analyses. Propensity-score matching was used, to control for selection bias due to nonrandom group assignment in a 1:1 manner, resulting in 432 pairs with balanced baseline characteristics. Results In unmatched groups, the 2nd-graft-arterial group had significantly lower rates of death (8.9{\%} vs 13.1{\%}; P =.02), and composite safety endpoint of death/stroke/myocardial infarction (13.3{\%} vs 18.7{\%}; P =.02), compared with the 2nd-graft-venous group. The rate of major adverse cardiac or cerebrovascular events was similar between groups (22.9{\%} vs 25.5{\%}; P =.30), because it includes the rate of repeat revascularization (12.6{\%} in the 2nd-graft-arterial group vs 9.6{\%} in the 2nd-graft-venous group; P =.10). After propensity-score matching, no statistically significant differences were found between groups. Conclusions This study reveals comparable 5-year outcomes with arterial and venous conduits as second grafts after an arterial graft anastomosed to the left anterior descending artery. This study demonstrates the multi-institutional variation in patient selection and operator technique with regard to arterial revascularization, although extended follow-up beyond 5 years is required to estimate its impact on long-term outcomes. Clinical Trial Number NCT00114972",
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T1 - The impact of a second arterial graft on 5-year outcomes after coronary artery bypass grafting in the Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery Trial and Registry

AU - Parasca, Catalina A.

AU - Head, Stuart J.

AU - Mohr, Friedrich W.

AU - Mack, Michael J.

AU - Morice, Marie Claude

AU - Holmes, David R.

AU - Feldman, Ted E.

AU - Colombo, Antonio

AU - Dawkins, Keith D.

AU - Serruys, Patrick W.

AU - Kappetein, Arie Pieter

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Objective Despite various evidence supporting the advantages of multiple arterial grafting, inconsistencies in use of the procedure have resulted in high variability in the acceptance and practice of arterial grafting. The purpose of this study was to assess the effects of an arterial versus venous second grafts on outcomes at 5-year follow-up in the coronary artery bypass grafting population from the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial. Methods Patients (n = 1419) with an arterial graft to the left anterior descending artery and ≥1 other graft were included and divided according to the second graft's type: 2nd-graft-arterial group (n = 456) and 2nd-graft-venous group (n = 963). Five-year outcomes were compared between subgroups. Event rates were estimated with Kaplan-Meier analyses. Propensity-score matching was used, to control for selection bias due to nonrandom group assignment in a 1:1 manner, resulting in 432 pairs with balanced baseline characteristics. Results In unmatched groups, the 2nd-graft-arterial group had significantly lower rates of death (8.9% vs 13.1%; P =.02), and composite safety endpoint of death/stroke/myocardial infarction (13.3% vs 18.7%; P =.02), compared with the 2nd-graft-venous group. The rate of major adverse cardiac or cerebrovascular events was similar between groups (22.9% vs 25.5%; P =.30), because it includes the rate of repeat revascularization (12.6% in the 2nd-graft-arterial group vs 9.6% in the 2nd-graft-venous group; P =.10). After propensity-score matching, no statistically significant differences were found between groups. Conclusions This study reveals comparable 5-year outcomes with arterial and venous conduits as second grafts after an arterial graft anastomosed to the left anterior descending artery. This study demonstrates the multi-institutional variation in patient selection and operator technique with regard to arterial revascularization, although extended follow-up beyond 5 years is required to estimate its impact on long-term outcomes. Clinical Trial Number NCT00114972

AB - Objective Despite various evidence supporting the advantages of multiple arterial grafting, inconsistencies in use of the procedure have resulted in high variability in the acceptance and practice of arterial grafting. The purpose of this study was to assess the effects of an arterial versus venous second grafts on outcomes at 5-year follow-up in the coronary artery bypass grafting population from the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial. Methods Patients (n = 1419) with an arterial graft to the left anterior descending artery and ≥1 other graft were included and divided according to the second graft's type: 2nd-graft-arterial group (n = 456) and 2nd-graft-venous group (n = 963). Five-year outcomes were compared between subgroups. Event rates were estimated with Kaplan-Meier analyses. Propensity-score matching was used, to control for selection bias due to nonrandom group assignment in a 1:1 manner, resulting in 432 pairs with balanced baseline characteristics. Results In unmatched groups, the 2nd-graft-arterial group had significantly lower rates of death (8.9% vs 13.1%; P =.02), and composite safety endpoint of death/stroke/myocardial infarction (13.3% vs 18.7%; P =.02), compared with the 2nd-graft-venous group. The rate of major adverse cardiac or cerebrovascular events was similar between groups (22.9% vs 25.5%; P =.30), because it includes the rate of repeat revascularization (12.6% in the 2nd-graft-arterial group vs 9.6% in the 2nd-graft-venous group; P =.10). After propensity-score matching, no statistically significant differences were found between groups. Conclusions This study reveals comparable 5-year outcomes with arterial and venous conduits as second grafts after an arterial graft anastomosed to the left anterior descending artery. This study demonstrates the multi-institutional variation in patient selection and operator technique with regard to arterial revascularization, although extended follow-up beyond 5 years is required to estimate its impact on long-term outcomes. Clinical Trial Number NCT00114972

KW - arterial graft

KW - coronary artery bypass

KW - SYNTAX

KW - venous graft

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