Association of Age With 10-Year Outcomes After Coronary Surgery in the Arterial Revascularization Trial

J Am Coll Cardiol. 2021 Jan 5;77(1):18-26. doi: 10.1016/j.jacc.2020.10.047.

Abstract

Background: The association of age with the outcomes of bilateral internal thoracic arteries (BITAs) versus single internal thoracic arteries (SITAs) for coronary bypass grafting (CABG) remains to be determined.

Objectives: The purpose of this study was to evaluate the association between age and BITA versus SITA outcomes in the Arterial Revascularization Trial.

Methods: The primary endpoints were all-cause mortality and a composite of major adverse events, including all-cause mortality, myocardial infarction, or stroke. Secondary endpoints were bleeding complications and sternal wound complications up to 6 months after surgery. Multivariable fractional polynomials analysis and log-rank tests were used.

Results: Age did not affect any of the explored outcomes in the overall BITA versus SITA comparison in the intention-to-treat analysis and in the analysis based on the number of arterial grafts received. However, when the intention-to-treat analysis was restricted to the populations of patients between age 50 and 70 years, younger patients in the BITA arm had a significantly lower incidence of major adverse events (p = 0.03).

Conclusions: Our results suggest that BITA may improve long-term outcome in younger patients, although more randomized data are needed to confirm this hypothesis.

Keywords: CABG; bilateral internal thoracic arteries; single internal thoracic artery.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Coronary Artery Bypass / adverse effects
  • Coronary Artery Bypass / methods*
  • Female
  • Hemorrhage / epidemiology
  • Humans
  • Intention to Treat Analysis
  • Internal Mammary-Coronary Artery Anastomosis / methods*
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology
  • Stroke / epidemiology