Choice of graft material at primary CABG influences cardiac death and reintervention rates.

OBJECTIVES To evaluate long-term survival and need for reintervention (redo CABG or percutaneous coronary artery transluminal angioplasty, PTCA) as a result of graft materials employed at the primary coronary artery bypass grafting (CABG). SUBJECTS AND METHODS 2,327 patients who underwent primary CABG between 1980 and 1990 were followed with regard to survival and reintervention requirements for a period of 10 years. There were three groups of patients. In group 1, CABG was performed between 1980 and 1982 using veins only. Group 2 subjects had CABG done from 1983 to 1985 using veins and internal thoracic artery (ITA). Those in group 3 received two ITAs (double ITA) from 1985 to 1990. Redo CABG and PTCS were performed as needed. RESULTS The 10-year cumulative survival figures for the groups were 92.8 % (group 1), 94.8% (group 2) and 95.4% (group 3). The difference between the groups was statistically significant (p < 0.001). Cardiac event-free survival was 74.4% (group 1), 83.5% (group 2) and 92.6% (group 3), with p < 0.0001. Myocardial infarction occurred more frequently in group 1 (4.7%) than in groups 2 or 3 (2.2 and 1.3%, respectively). The redo rates for CABG were 13.6% (group 1), 8.1% (group 2), and 1.3% (group 3). The corresponding PTCA rates for the three groups were 7.1, 3.7 and 1.6%, respectively (p < 0.0001). CONCLUSIONS Double ITA, compared with single ITA and/or vein grafts, was the optimal graft material at the time of primary CABG because it had the lowest reintervention rate. It also did not increase postoperative morbidity.