A meta-analysis comparing bilateral internal mammary artery with left internal mammary artery for coronary artery bypass grafting

Aaron J Weiss, Shan Zhao, David Tian, David P. Taggart, Tristan Yan

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Increasing evidence continues to demonstrate a survival advantage for bilateral internal mammary artery (BIMA) over left internal mammary artery (LIMA) for coronary artery bypass grafting (CABG). We performed an updated meta-analysis of published studies comparing BIMA versus LIMA in CABG operations and assessed differences in long-term survival.

METHODS: Electronic searches for studies comparing BIMA versus LIMA were performed using three databases from 1972 to December 2012. Studies with at least four years of follow-up and at least 100 patients in each group were included for review. We used a random-effect model and pooled hazard ratios from across all included studies.

RESULTS: No randomized controlled trials and 27 observational studies totaling 79,063 patients (19,277 BIMA, 59,786 LIMA) were included for final analysis. The BIMA group demonstrated significantly better long-term survival than the LIMA group [hazard ratio, 0.78; confidence interval, 0.72-0.84; P<0.00001].

CONCLUSIONS: In an updated meta-analysis, we demonstrate an increase in long-term survival in patients receiving BIMA as a primary grafting strategy over those receiving a LIMA. Although no randomized controlled trials were included in this meta-analysis, the survival benefit seen with a BIMA cannot be overlooked when determining which operation to perform in CABG patients. Until the long-term results of the ART trial are published, we offer best available evidence in favor of BIMA over LIMA for CABG surgery.

Original languageEnglish
Pages (from-to)390-400
Number of pages11
JournalAnnals of Cardiothoracic Surgery
Volume2
Issue number4
DOIs
Publication statusPublished - Jul 2013
Externally publishedYes

Keywords

  • Journal Article

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