Survival effect of radial artery usage in addition to bilateral internal thoracic arterial grafting: A meta-analysis

Formica, Francesco; Maestri, Francesco; D’Alessandro, Stefano; Mauro, Michele Di; Singh, Gurmeet; Gallingani, Alan; Nicolini, Francesco

doi:10.1016/j.jtcvs.2021.06.062

Cited by 15 publications

(2 citation statements)

References 46 publications

(65 reference statements)

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“…Several factors, including the extensive use of multiple arterial grafts (MAG) and performing graft anastomosis distal to the coronary stenosis, are associated with the significant reduction in mortality incidence in long-term follow-up. Several studies have reported a very high late survival rate (beyond 10-years) in patients who underwent CABG with MAG and these findings should be considered in Heart Team discussions (25)(26)(27)(28)(29). At the same time, advances in DES technology and increased adherence to dual antiplatelet therapy could really help to increasingly reduce the incidence of mortality and complications after PCI (30,31).…”

Section: Discussionmentioning

confidence: 99%

Surgical and percutaneous coronary revascularization in patients with multivessel or left main disease; what happens beyond five years? A systematic review and study level meta-analysis of randomized trials

Formica¹,

Hernández-Vaquero

Tuttolomondo

et al. 2023

Preprint

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Meta-analysis exploring outcomes beyond 5-years of trials comparing coronary artery bypass graft (CABG) with percutaneous coronary intervention (PCI) utilizing drug-eluting stents in patients with coronary artery disease (CAD), are missing. We conducted a meta-analysis to compare very long-term outcomes, between the two interventions. Using electronic databases, we retrieved 4 trials, between January, 2010 and January, 2023. The primary endpoint was all-cause mortality. Kaplan-Meier curves of endpoint was reconstructed. Comparisons were made by Cox-linear regression frailty model and by landmark analysis. A flexible parametric model for survival analysis was used to obtain the time-dependent hazard-ratio. A random-effect method was applied. 5180 patients were included and randomized to CABG (n=2586) or PCI with DES (n=2594). During 10-year follow-up, PCI showed an overall higher incidence of all-cause mortality [hazard ratio (HR) 1.19; 95% confidence interval (CI), 1.104-1.32; p=0.008)]. At landmark analysis, PCI showed higher risk of the endpoint within 5-years (HR 1.2; 95% CI, 1.06-1.53; p=0.008) while no difference was found at 5-10-year period (HR,1.03; 95%CI, 0.84-1.26; p=0.76). The time-varying HR analysis of PCI versus CABG was consistent with the results of the landmark analysis. There was no long-term difference between the two interventions for myocardial infarction (MI) (OR,1.42; 95%CI, 0.92-2.18; p=0.11), composite of all-cause mortality, stroke or MI (OR,1.07; 95%CI, 0.84-1.36; p=0.57), stroke (OR,0.97; 95%CI, 0.59-1.59; p=0.91) and cardiovascular death (OR,1.02; 95%CI, 0.75-1.40; p=0.90), while PCI was associated with an increased risk for repeat revascularization (OR,2.11; 95%CI, 1.58-2.81; p<0.001) and major adverse cardiac and cerebrovascular events (OR,1.41; 95%CI, 1.13-1.75; p<0.0001). In conclusion, in patients with CAD, there was a significantly overall higher incidence of all-cause mortality after PCI compared to CABG beyond 5-year follow-up. Specifically, CABG is still favorable beyond 5 years and maintains its gold standard role for the CAD treatment; PCI has an evident higher mortality during the first 5 years and a comparable outcome beyond 5 years.

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Section: Discussionmentioning

confidence: 99%

Surgical and percutaneous coronary revascularization in patients with multivessel or left main disease; what happens beyond five years? A systematic review and study level meta-analysis of randomized trials

Formica¹,

Hernández-Vaquero

Tuttolomondo

et al. 2023

Preprint

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“…Even the use of the RA in addition to BIMA is associated with a better long-term survival compared with BIMA and SV grafting. 7 Moreover, the effect of skeletonized artery of patency is to be related to surgeon-related factors rather than to the intrinsic biology of skeletonized artery. 8 We believe that emphasis should be placed on increasing use of MAG/TAG, especially in patients with a long life expectancy.…”

Section: Multiple and Total Arterial Grafts Are Not A Mirage Anymore!...mentioning

confidence: 99%

Multiple and total arterial grafts are not a mirage anymore!

Formica¹,

Gallingani²,

Maestri³

et al. 2023

JTCVS Open

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Twenty-year outcomes of free and I-composite radial artery grafts for coronary artery revascularization

et al. 2023

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Survival effect of radial artery usage in addition to bilateral internal thoracic arterial grafting: A meta-analysis

Cited by 15 publications

References 46 publications

Surgical and percutaneous coronary revascularization in patients with multivessel or left main disease; what happens beyond five years? A systematic review and study level meta-analysis of randomized trials

Surgical and percutaneous coronary revascularization in patients with multivessel or left main disease; what happens beyond five years? A systematic review and study level meta-analysis of randomized trials

Multiple and total arterial grafts are not a mirage anymore!

Twenty-year outcomes of free and I-composite radial artery grafts for coronary artery revascularization

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