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Ann Thorac Surg 2006;81:1243-1248
© 2006 The Society of Thoracic Surgeons
a Dalhousie University, Halifax, Nova Scotia, Canada
b Papworth Hospital, Cambridge
c Dendrite Clinical Systems, Reading, United Kingdom
d University College, London (on behalf of the Society of Cardiothoracic Surgeons of Great Britain & Ireland), United Kingdom
Accepted for publication December 1, 2005.
* Address correspondence to Dr Baskett, Room 2269, 1796 Summer St, Halifax, Nova Scotia, Canada, B3H 3A7 (Email: rogerbaskett{at}hotmail.com).
BACKGROUND: The purpose of this study was to assess the use of arterial revascularization and to compare the in-hospital mortality with other CABG grafting strategies.
METHODS: A total of 71,470 CABG patients (1992–2001) in 27 centers in the United Kingdom were studied. The proportion of patients with arterial revascularization was compared. In-hospital mortality was compared for various grafting strategies: all-arterial (n = 5,401), all non-all-arterial patients (n = 66,069), one artery any number of veins (n = 49,801). The groups were compared for in-hospital mortality using multivariate logistic regression to assess the independent effect of the grafting strategies on mortality; logistic EuroSCORE-predicted mortality was compared to actual mortality, and all arterial and one artery and veins patients were compared with propensity score analysis.
RESULTS: There was a significant increase in the proportion of all-arterial patients over time (3.2% to 11.7%, p< 0.001) with evidence of variability across centers. Crude mortality for all-arterial patients was 2% vs 3% for all non-all-arterial patients (p < 0.001). In multivariate analysis, all-arterial was associated with a slight but insignificant increase in in-hospital mortality (odds ratio [OR] 1.13; [95% confidence interval {CI} 0.86–1.48], p = 0.36). There was a trend toward higher mortality in the all-arterial group when compared with the one artery and veins group (OR 1.19 [95% CI 0.91–1.56], p = 0.10). The one artery and veins group was the only group where actual mortality was significantly lower than predicted by EuroSCORE (p < 0.001). In propensity analysis the mortality was 1.51% for one artery and veins and 1.74% of all-arterial patients (p = 0.56).
CONCLUSIONS: The use of arterial grafting has increased over time, varies by center, and appears to be safe in terms of in-hospital mortality.
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