Effect of total arterial grafting in the Arterial Revascularization Trial

David P Taggart, Mario Gaudino*, Stephen Gerry, Alastair Gray, Belinda Lees, Arnaldo Dimagli, John D. Puskas, Vipin Zamvar, Rafal Pawlaczyk, Alistair Royse, Marcus Flather, Umberto Benedetto

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Objectives
The Arterial Revascularization Trial (ART) was designed to compare 10-year survival in bilateral versus single internal thoracic artery grafts. The intention-to-treat analysis has showed comparable outcomes between the 2 groups but an explanatory analysis suggested that those receiving 2 or more arterial grafts had better survival. Whether the exclusive use of arterial grafts provide further benefit is unclear.

Methods
We performed an exploratory analysis of the ART based on conduits actually received (as-treated principle). From ART cohort, only patients receiving at least 3 grafts were included. The final population consisted of 1084, 1010, and 390 patients in the single arterial graft (SAG) group, in the multiple arterial graft (MAG) group (2 or more arterial grafts with additional saphenous veins) and total arterial graft (TAG) group (3 or more arterial grafts only) respectively. Inverse probability of treatment weighting was used for comparison.

Results
When compared with the SAG group, there was a significant trend toward a reduction of 10-year mortality in the MAG and TAG group (test for trend P = .02). The TAG group was associated with the lowest risk of late mortality (hazard ratio, 0.68; 95% confidence interval, 0.48-0.96; P = .03) and with a significant risk reduction of the composite of death/myocardial infarction/stroke and repeat revascularization (hazard ratio, 0.71; 95% confidence interval, 0.53-0.94; P = .02).

Conclusions
When compared with SAG, both MAG and TAG represent valuable strategies to improve clinical outcomes following coronary artery bypass grafting but TAG can potentially provide further benefit.
Original languageEnglish
Number of pages15
JournalJournal of Thoracic and Cardiovascular Surgery
Early online date19 Mar 2020
DOIs
Publication statusE-pub ahead of print - 19 Mar 2020

Structured keywords

  • Bristol Heart Institute

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