Kei Kobayashi, Xander Jacqemyn, Jianhui Zhu, Floyd W Thoma, Derek Serna-Gallegos, David Kaczorowski, Johannes Bonatti, Francis Ferdinand, David West, Takuya Ogami, Nathan J Chu, Irsa Hasan, Danny Chu
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引用次数: 0
Abstract
Background: The interaction between conduit strategy and longitudinal guideline-directed medical therapy (GDMT) adherence remains unclear.
Objectives: To compare long-term outcomes between patients who underwent GDMT-compliant single internal mammary artery (SIMA) grafting and GDMT-noncompliant bilateral internal mammary artery (BIMA) grafting in isolated primary coronary artery bypass grafting (CABG).
Methods: Adults ≥18 years of age who underwent isolated CABG with SIMA or BIMA between 2011-2024 were retrospectively analyzed. GDMT compliance was defined as ≥80% medication coverage from discharge to first major adverse cardiovascular event (MACE) or censoring (through last follow-up if no MACE). Patients were restricted to GDMT-compliant SIMA with saphenous vein grafts (cSIMA) versus GDMT-noncompliant BIMA with saphenous vein grafts (ncBIMA). Propensity-score matching (1:4) was performed. The primary endpoint was time to first MACE (all-cause mortality, myocardial infarction (MI), and repeat revascularization).
Results: Matching yielded 157 ncBIMA and 618 cSIMA with similar follow-up (8.13 vs 7.62years, p=0.143). ncBIMA more often received ≥3 grafts (87.3 vs 70.6%, p<0.001). Time-to-event analyses demonstrated higher cumulative MACE in cSIMA (5-year 22.5 vs 12.1%; 10-year 39.7 vs 29.1%; log-rank p=0.0394) and higher cumulative incidence of MI hospitalization (Gray's p=0.0096) and revascularization (Gray's p=0.0028). After adjustment for pump status and graft number, cSIMA remained associated with higher hazards of MACE (HR1.54, 95%CI 1.07-2.20), MI hospitalization (HR2.10, 95%CI 1.01-4.36), and revascularization (HR3.01, 95%CI 1.50-6.03).
Conclusions: Despite GDMT compliance, cSIMA was associated with higher long-term MACE than ncBIMA, driven by MI hospitalization and repeat revascularization, supporting broader consideration of BIMA in appropriately selected patients in maximizing survival benefit.
期刊介绍：
Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.
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