Jordan Leith, Kevin R An, Lamia Harik, Michele Dell'Aquila, Camilla Sofia Rossi, Gianmarco Cancelli, Giovanni Soletti, Stephen E Fremes, David L Hare, Alexander Kulik, Andre Lamy, Marc Ruel, Joyce Peper, Jurrien M Ten Berg, Laura M Willemsen, Qiang Zhao, Yunpeng Zhu, John H Alexander, Daniel M Wojdyla, C Michael Gibson, Bjorn Redfors, Sigrid Sandner, Mario Gaudino
{"title":"从左胸内动脉到左前降支动脉的顺序移植和移植失败。","authors":"Jordan Leith, Kevin R An, Lamia Harik, Michele Dell'Aquila, Camilla Sofia Rossi, Gianmarco Cancelli, Giovanni Soletti, Stephen E Fremes, David L Hare, Alexander Kulik, Andre Lamy, Marc Ruel, Joyce Peper, Jurrien M Ten Berg, Laura M Willemsen, Qiang Zhao, Yunpeng Zhu, John H Alexander, Daniel M Wojdyla, C Michael Gibson, Bjorn Redfors, Sigrid Sandner, Mario Gaudino","doi":"10.1016/j.athoracsur.2024.11.009","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>There is concern that left internal thoracic artery (LITA) to diagonal to left anterior descending artery (LAD) grafts may be more susceptible to failure compared to single LITA-LAD grafts.</p><p><strong>Methods: </strong>Pooled individual patient data from eight clinical trials with systematic graft imaging were analyzed to assess the incidence of sequential LITA-Diagonal-LAD vs. single LITA-LAD grafts. Mixed-effects multivariable logistic regression, adjusting for patient characteristics and clustering within trials, was used.</p><p><strong>Results: </strong>Of 3969 patients with LITA-LAD grafts, 283 (7.1%) patients received sequential LITA-Diagonal-LAD grafts. Patients with sequential LITA-Diagonal-LAD grafts were older (66 vs. 65 y, p=0.009) and more often male (88% vs. 83%, p=0.03). Overall, graft failure occurred in 9.3% of patients with LITA-LAD grafts, with more graft failure occurring in single (9.5%) than in sequential LITA-Diagonal-LAD grafts (6.4%, p=0.08) at a median (25<sup>th</sup>-75<sup>th</sup> percentile) time to imaging of 1.0 (1.0-1.1) years. After multivariable adjustment, sequential LITA-Diagonal-LAD grafting was not associated with graft failure (adjusted odds ratio: 1.22, 95% confidence interval: 0.68-2.18, p=0.55). There was no difference in mortality (2.8% vs. 5.3%, p=0.06), myocardial infarction (1.4% vs. 1.6%, p=0.90), revascularization (4.5% vs. 7.3%, p=0.08), or stroke (1.7% vs. 1.2%, p=0.40) between groups.</p><p><strong>Conclusions: </strong>In selected patients, LITA-Diagonal-LAD grafting was not associated with higher risk of graft failure or adverse clinical events at one year.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Sequential Grafting of the Left Internal Thoracic Artery to the Left Anterior Descending Artery and Graft Failure.\",\"authors\":\"Jordan Leith, Kevin R An, Lamia Harik, Michele Dell'Aquila, Camilla Sofia Rossi, Gianmarco Cancelli, Giovanni Soletti, Stephen E Fremes, David L Hare, Alexander Kulik, Andre Lamy, Marc Ruel, Joyce Peper, Jurrien M Ten Berg, Laura M Willemsen, Qiang Zhao, Yunpeng Zhu, John H Alexander, Daniel M Wojdyla, C Michael Gibson, Bjorn Redfors, Sigrid Sandner, Mario Gaudino\",\"doi\":\"10.1016/j.athoracsur.2024.11.009\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>There is concern that left internal thoracic artery (LITA) to diagonal to left anterior descending artery (LAD) grafts may be more susceptible to failure compared to single LITA-LAD grafts.</p><p><strong>Methods: </strong>Pooled individual patient data from eight clinical trials with systematic graft imaging were analyzed to assess the incidence of sequential LITA-Diagonal-LAD vs. single LITA-LAD grafts. Mixed-effects multivariable logistic regression, adjusting for patient characteristics and clustering within trials, was used.</p><p><strong>Results: </strong>Of 3969 patients with LITA-LAD grafts, 283 (7.1%) patients received sequential LITA-Diagonal-LAD grafts. Patients with sequential LITA-Diagonal-LAD grafts were older (66 vs. 65 y, p=0.009) and more often male (88% vs. 83%, p=0.03). Overall, graft failure occurred in 9.3% of patients with LITA-LAD grafts, with more graft failure occurring in single (9.5%) than in sequential LITA-Diagonal-LAD grafts (6.4%, p=0.08) at a median (25<sup>th</sup>-75<sup>th</sup> percentile) time to imaging of 1.0 (1.0-1.1) years. After multivariable adjustment, sequential LITA-Diagonal-LAD grafting was not associated with graft failure (adjusted odds ratio: 1.22, 95% confidence interval: 0.68-2.18, p=0.55). There was no difference in mortality (2.8% vs. 5.3%, p=0.06), myocardial infarction (1.4% vs. 1.6%, p=0.90), revascularization (4.5% vs. 7.3%, p=0.08), or stroke (1.7% vs. 1.2%, p=0.40) between groups.</p><p><strong>Conclusions: </strong>In selected patients, LITA-Diagonal-LAD grafting was not associated with higher risk of graft failure or adverse clinical events at one year.</p>\",\"PeriodicalId\":50976,\"journal\":{\"name\":\"Annals of Thoracic Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2024-11-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Thoracic Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.athoracsur.2024.11.009\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Thoracic Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.athoracsur.2024.11.009","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景：与单一 LITA-LAD 移植物相比，左胸内动脉 (LITA) 对角线至左前降支动脉 (LAD) 移植物可能更容易失败：方法： 分析了八项具有系统移植物成像的临床试验中汇总的单个患者数据，以评估LITA-对角线-LAD顺序移植物与单一LITA-LAD移植物的发生率。采用混合效应多变量逻辑回归，对患者特征和试验内的聚类进行调整：结果：在3969名接受LITA-LAD移植物治疗的患者中，283名（7.1%）患者接受了LITA-对角线-LAD连续移植物治疗。接受LITA-LAD对角线连续移植的患者年龄较大（66岁对65岁，P=0.009），男性较多（88%对83%，P=0.03）。总体而言，9.3%的LITA-LAD移植物患者发生了移植物失败，在中位（第25-75百分位数）成像时间为1.0（1.0-1.1）年时，单次（9.5%）LITA-对角线-LAD连续移植物（6.4%，P=0.08）发生移植物失败的比例高于连续移植物（6.4%，P=0.08）。经多变量调整后，LITA-对角线-LAD 顺序移植与移植失败无关（调整后的几率比：1.22，95% 置信区间：0.68-2.18，P=0.55）。各组之间的死亡率（2.8% vs. 5.3%，P=0.06）、心肌梗死（1.4% vs. 1.6%，P=0.90）、血管再通（4.5% vs. 7.3%，P=0.08）或中风（1.7% vs. 1.2%，P=0.40）没有差异：结论：在选定的患者中，LITA-对角线-LAD移植术与移植失败或一年后不良临床事件的较高风险无关。
Sequential Grafting of the Left Internal Thoracic Artery to the Left Anterior Descending Artery and Graft Failure.
Background: There is concern that left internal thoracic artery (LITA) to diagonal to left anterior descending artery (LAD) grafts may be more susceptible to failure compared to single LITA-LAD grafts.
Methods: Pooled individual patient data from eight clinical trials with systematic graft imaging were analyzed to assess the incidence of sequential LITA-Diagonal-LAD vs. single LITA-LAD grafts. Mixed-effects multivariable logistic regression, adjusting for patient characteristics and clustering within trials, was used.
Results: Of 3969 patients with LITA-LAD grafts, 283 (7.1%) patients received sequential LITA-Diagonal-LAD grafts. Patients with sequential LITA-Diagonal-LAD grafts were older (66 vs. 65 y, p=0.009) and more often male (88% vs. 83%, p=0.03). Overall, graft failure occurred in 9.3% of patients with LITA-LAD grafts, with more graft failure occurring in single (9.5%) than in sequential LITA-Diagonal-LAD grafts (6.4%, p=0.08) at a median (25th-75th percentile) time to imaging of 1.0 (1.0-1.1) years. After multivariable adjustment, sequential LITA-Diagonal-LAD grafting was not associated with graft failure (adjusted odds ratio: 1.22, 95% confidence interval: 0.68-2.18, p=0.55). There was no difference in mortality (2.8% vs. 5.3%, p=0.06), myocardial infarction (1.4% vs. 1.6%, p=0.90), revascularization (4.5% vs. 7.3%, p=0.08), or stroke (1.7% vs. 1.2%, p=0.40) between groups.
Conclusions: In selected patients, LITA-Diagonal-LAD grafting was not associated with higher risk of graft failure or adverse clinical events at one year.
期刊介绍：
The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards.
The Annals of Thoracic Surgery features:
• Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques
• New Technology articles
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• Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery.
An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.
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