胸内动脉
医学
危险系数
倾向得分匹配
动脉
置信区间
外科
比例危险模型
嫁接
旁路移植
心脏病学
存活率
血运重建
回顾性队列研究
心胸外科
内科学
生存分析
作者
Daniel Navia,Juan Espinoza,Mariano Vrancic,Fernando Piccinini,Mariano Camporrotondo,Alberto Dorsa,Leonardo Seoane
标识
DOI:10.1016/j.jtcvs.2020.09.101
摘要
Abstract
Objective
The purpose of the present study was to compare survival outcomes in propensity score–matched patients aged 70 years or greater receiving a bilateral internal thoracic artery graft with patients receiving a single internal thoracic artery graft. Methods
Among 4083 consecutive patients with isolated coronary artery bypass grafting who underwent operation between January 2001 and December 2018, we identified 1300 patients aged 70 years or greater; of these, 968 received a bilateral internal thoracic artery (bilateral internal thoracic artery group) and 332 received a single internal thoracic artery (single internal thoracic artery group). Propensity score matching was used to reduce the preoperative patient differences. The 10-year survival and postoperative complications were compared between the 2 groups. Results
A Kaplan–Meier curve at 10 years of follow-up showed that crude survival was significantly superior in patients with bilateral internal thoracic artery grafts than in patients with single internal thoracic artery grafts (67.0% ± 2.5% vs 56.0% ± 3.4%, respectively; P < .016). In the actuarial survival, estimates for propensity score–matched patients with a bilateral internal thoracic artery showed a significantly higher rates of survival than patients with a single internal thoracic artery by the end of follow-up (66.0% ± 5.3% vs 53.0% ± 3.9%, respectively; hazard ratio, 0.64; 95% confidence interval, 0.44-0.94; P = .022, univariable Cox Model and multivariable analysis hazard ratio, 0.66; 95% confidence interval, 0.45-0.97; P = .036 Cox model). Postoperative complications were all similar between the single internal thoracic artery and bilateral internal thoracic artery groups. Conclusions
The use of bilateral internal thoracic artery grafting in older patients improves 10-year survival, with similar postoperative morbidity. This surgical technique might have beneficial effects in survival in patients aged more than 70 years. Its use could be considered more frequently.
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