Cited by 388Cardiac and Coronary Surgery TechniquesCoronary Interventions and DiagnosticsCardiac Imaging and Diagnostics

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Randomized Trial of Bilateral versus Single Internal-Thoracic-Artery Grafts

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Taggart, David P., Altman, Douglas G., Gray, Alastair M., Lees, Belinda, Gerry, Stephen, Benedetto, Umberto, Flather, Marcus·2016·New England Journal of Medicine

DOI 10.1056/nejmoa1610021

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Abstract

BACKGROUND: The use of bilateral internal thoracic (mammary) arteries for coronary-artery bypass grafting (CABG) may improve long-term outcomes as compared with the use of a single internal-thoracic-artery plus vein grafts. METHODS: We randomly assigned patients scheduled for CABG to undergo single or bilateral internal-thoracic-artery grafting in 28 cardiac surgical centers in seven countries. The primary outcome was death from any cause at 10 years. The composite of death from any cause, myocardial infarction, or stroke was a secondary outcome. Interim analyses were prespecified at 5 years of follow-up. RESULTS: A total of 3102 patients were enrolled; 1554 were randomly assigned to undergo single internal-thoracic-artery grafting (the single-graft group) and 1548 to undergo bilateral internal-thoracic-artery grafting (the bilateral-graft group). At 5 years of follow-up, the rate of death was 8.7% in the bilateral-graft group and 8.4% in the single-graft group (hazard ratio, 1.04; 95% confidence interval [CI], 0.81 to 1.32; P=0.77), and the rate of the composite of death from any cause, myocardial infarction, or stroke was 12.2% and 12.7%, respectively (hazard ratio, 0.96; 95% CI, 0.79 to 1.17; P=0.69). The rate of sternal wound complication was 3.5% in the bilateral-graft group versus 1.9% in the single-graft group (P=0.005), and the rate of sternal reconstruction was 1.9% versus 0.6% (P=0.002). CONCLUSIONS: Among patients undergoing CABG, there was no significant difference between those receiving single internal-thoracic-artery grafts and those receiving bilateral internal-thoracic-artery grafts with regard to mortality or the rates of cardiovascular events at 5 years of follow-up. There were more sternal wound complications with bilateral internal-thoracic-artery grafting than with single internal-thoracic-artery grafting. Ten-year follow-up is ongoing. (Funded by the British Heart Foundation and others; ART Current Controlled Trials number, ISRCTN46552265 .).

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Authors: Taggart, D. P., Altman, D. G., Gray, A. M., Lees, B., Gerry, S., Benedetto, U., & Flather, M.
Affiliations: University of East Anglia (GB)
ORCID: Taggart, David P.
Altman, Douglas G.
Gray, Alastair M.
Lees, Belinda
Gerry, Stephen
Benedetto, Umberto
Flather, Marcus
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2016-12-29
Volume: 375
Issue: 26
Pages: 2540-2549
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa1610021
OpenAlex: W2554597692
Cited by: 388
References: 46
Citations by year: 2026: 11 · 2025: 15 · 2024: 22 · 2023: 21 · 2022: 25 · 2021: 29 · 2020: 29 · 2019: 52 · 2018: 107 · 2017: 75 · 2016: 2
FWCI: 87.09
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Bristol Research (University of Bristol) (publishedVersion, other-oa)
UEA Digital Repository (University of East Anglia) (acceptedVersion)
Northumbria Research Link (Northumbria University) (submittedVersion)
Funders: Cancer Research UK (16895)
National Institute for Health and Care Research (CDF-2015-08-074)
British Heart Foundation
Medical Research Council
Topics: Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Coronary Interventions and Diagnostics
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Keywords: coronary artery bypass grafting, bilateral internal thoracic artery grafting, long-term mortality, myocardial infarction, stroke, sternal wound complications, sternal reconstruction, vein grafts, coronary artery disease surgery, postoperative outcomes, 10-year follow-up
MeSH terms: Aged, Coronary Artery Bypass, Cause of Death, Coronary Artery Disease, Female, Follow-Up Studies, Humans, Male, Mammary Arteries, Middle Aged, Myocardial Infarction, Incidence, Survival Rate, Stroke

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Randomized Trial of Bilateral versus Single Internal-Thoracic-Artery Grafts

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