Abstract:
OBJECTIVES:The aim of this study was to assess the pattern of the adoption of internal mammary artery (IMA) grafting in the United States, test its association with clinical outcomes, and assess whether its effectiveness differs in key clinical subgroups. BACKGROUND:The effect of IMA grafting on major clinical outcomes has never been tested in a large randomized trial, yet it is now a quality standard for coronary artery bypass graft (CABG) surgery. METHODS:We identified Medicare beneficiaries ≥66 years of age who underwent isolated multivessel CABG between 1988 and 2008, and we documented patterns of IMA use over time. We used a multivariable propensity score to match patients with and without an IMA and compared rates of death, myocardial infarction (MI), and repeat revascularization. We tested for variations in IMA effectiveness with treatment × covariate interaction tests. RESULTS:The IMA use in CABG rose slowly from 31% in 1988 to 91% in 2008, with persistent wide geographic variations. Among 60,896 propensity score-matched patients over a median 6.8-year follow-up, IMA use was associated with lower all-cause mortality (adjusted hazard ratio: 0.77, p < 0.001), lower death or MI (adjusted hazard ratio: 0.77, p < 0.001), and fewer repeat revascularizations over 5 years (8% vs. 9%, p < 0.001). The association between IMA use and lower mortality was significantly weaker (p ≤ 0.008) for older patients, women, and patients with diabetes or peripheral arterial disease. CONCLUSIONS:Internal mammary artery grafting was adopted slowly and still shows substantial geographic variation. IMA use is associated with lower rates of death, MI, and repeat coronary revascularization.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Hlatky MA,Boothroyd DB,Reitz BA,Shilane DA,Baker LC,Go ASdoi
10.1016/j.jacc.2013.08.1632subject
Has Abstractpub_date
2014-01-07 00:00:00pages
33-9issue
1eissn
0735-1097issn
1558-3597pii
S0735-1097(13)05434-Xjournal_volume
63pub_type
杂志文章,多中心研究abstract:OBJECTIVES:We designed a study to explore the effect of glycoprotein (GP) IIb/IIIa blockade on the atherosclerotic plaque and distal coronary vasculature. BACKGROUND:Platelet GP IIb/IIIa blockers have been proven to be beneficial in acute ischemic syndromes. This effect has also been attributed to the prevention of mi...
journal_title:Journal of the American College of Cardiology
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abstract::The accuracy of a computer system that was developed for the analysis of ST segment changes recorded on Holter ambulatory electrocardiographic monitoring tapes was compared with conventional visual scrutiny, beat by beat analog printouts and a commercial J point trend system. The program calculates and plots multiple ...
journal_title:Journal of the American College of Cardiology
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更新日期:2009-10-20 00:00:00
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更新日期:2018-12-11 00:00:00
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更新日期:2002-09-04 00:00:00
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更新日期:2011-09-13 00:00:00
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journal_title:Journal of the American College of Cardiology
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更新日期:2007-10-02 00:00:00
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更新日期:2000-04-01 00:00:00