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Superior Outcomes of Dual-Arterial Coronary Artery Bypass Grafting Are Maintained in the Veterans Health Administration.
Gikandi, Ajami; Tran, Dinh; Mi, Zhibao; DeMatt, Ellen; Quin, Jacquelyn A; Kinlay, Scott; Biswas, Kousick; Zenati, Marco A.
Afiliación
  • Gikandi A; Division of Cardiac Surgery, Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, Boston, Massachusetts; Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
  • Tran D; U.S. Department of Veterans Affairs, VA Cooperative Studies Program Coordinating Center, Office of Research and Development, Perry Point, Maryland.
  • Mi Z; U.S. Department of Veterans Affairs, VA Cooperative Studies Program Coordinating Center, Office of Research and Development, Perry Point, Maryland.
  • DeMatt E; U.S. Department of Veterans Affairs, VA Cooperative Studies Program Coordinating Center, Office of Research and Development, Perry Point, Maryland.
  • Quin JA; Division of Cardiac Surgery, Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, Boston, Massachusetts.
  • Kinlay S; Division of Cardiology, Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, Boston, Massachusetts.
  • Biswas K; U.S. Department of Veterans Affairs, VA Cooperative Studies Program Coordinating Center, Office of Research and Development, Perry Point, Maryland.
  • Zenati MA; Division of Cardiac Surgery, Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, Boston, Massachusetts; Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: marco_zenati@hms.harvard.edu.
J Surg Res ; 301: 240-246, 2024 Sep.
Article en En | MEDLINE | ID: mdl-38970871
ABSTRACT

INTRODUCTION:

Controversy surrounds the long-term clinical benefit of coronary artery bypass grafting (CABG) using dual arterial grafts (DAGs) compared to single arterial grafts (SAGs). We investigated outcomes of DAG, using single internal thoracic artery and radial artery (DAG-RA) or bilateral internal thoracic artery grafts (DAG-BITA), compared to SAG, using the left internal thoracic artery and saphenous vein grafts, in the U.S. Veterans Health Administration (VA).

METHODS:

We conducted a cross-sectional study of U.S. Veterans undergoing isolated on-pump CABG between 2005 and 2015 at 44 VA medical centers. The primary composite outcome was first occurrence of a major adverse cardiac and cerebrovascular event (MACCE), comprised of death from any cause, myocardial infarction, stroke, or repeat revascularization.

RESULTS:

Among 25,969 Veterans undergoing isolated CABG, 1261 (4.9%) underwent DAG (66.8% DAG-RA and 33.2% DAG-BITA). Over a 5-y follow-up, DAG was associated with lower rates of all-cause death (adjusted hazard ratio [AHR] 0.70, 95% confidence interval [CI] 0.58-0.85), MACCE (AHR 0.80, 95% CI 0.71-0.91), and stroke (AHR 0.74, 95% CI 0.57-0.96) versus SAG. DAG-BITA was associated with lower rates of all-cause death (AHR 0.52, 95% CI 0.35-0.77) and MACCE (AHR 0.66, 95% CI 0.51-0.84) than SAG, while DAG-RA was associated with lower rates of all-cause death (AHR 0.79, 95% CI 0.64-0.99).

CONCLUSIONS:

In the VA, DAG was associated with improved long-term MACCE outcomes compared to SAG. These results suggest that the practice of DAG in the VA benefits Veterans and should be promoted further.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Puente de Arteria Coronaria / United States Department of Veterans Affairs Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: J Surg Res Año: 2024 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Puente de Arteria Coronaria / United States Department of Veterans Affairs Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: J Surg Res Año: 2024 Tipo del documento: Article
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