SITA+Vein vs 2nd-arterial conduit
Baseline characteristics of patients in the unmatched and matched cohort are presented in Table-1. In the unmatched cohort, patients in the SITA+Vein group presented higher prevalence of comorbidities. In particular they were more likely to be older, female and to have peripheral vascular disease, diabetes, history of cerebrovascular adverse events, recent myocardial infarction, impaired left ventricular function, moderate and severe renal impairment. Whereas patients in the 2nd arterial conduit group were more likely to be active smokers and emergent or urgent cases and to have history of percutaneous coronary interventions, hyperlipidemia and left main disease. After PS-matching, both groups were comparable for all baseline characteristics(Table-1). PS-matching selected 695-pairs and both groups were found to be well balanced.
The mean number of grafts performed in the SITA+Vein group was higher than in the 2nd-arterial conduit group before(p<0.001) as well as after PS-matching(p<0.001). In the unmatched, no difference was observed between both groups in terms of OPCAB vs ONCAB or prevalence of IR. However, after matching, 2nd-arterial conduit group had higher rate of OPCAB(46.9% vs 36.9% in the SITA+Vein group;p<0.001) and higher rate of IR(25.8% vs 20.0% in the SITA+Vein group;p=0.008)(Table-1).
Before as well as after PS-matching, no significant differences were observed between both groups in terms of 30-day mortality, 30-day MACCE, reoperation for bleeding and incidence of DSWI(Table-2).
In the unmatched cohort, mean follow‐up was 7.2±3.66-years. Survival at-5,-10 and 14-years were 92.6% vs 85.6%, 80.2% vs 68.1% and 73.2% vs 54.8% in the 2nd arterial conduit group vs SITA+Vein group, respectively(Log-rank p<0.001)(Figure.2A). In the matched cohort, mean follow-up was 7.74±3.79-years. Survival at-5,-10 and 14-years were 92.6% vs 89.7%, 79.9% vs 78.3% and 72.4% vs 61.1% in the 2nd arterial conduit group vs SITA+Vein group, respectively(Log-rank p=0.04)(Figure.2B). The use of 2nd-arterial graft was associated with a significant reduction in long-term mortality before(HR:0.52;95%CI;0.43-0.64;p<0.001) as well as after PS-matching(HR:0.77;95%CI;0.60-0.99;p=0.04).
Cox regression models were used to find the univariable and multivariable predictors of late all-cause mortality. Multivariable analysis identified the presence of 2nd-arterial conduit as a significant predictor of improved survival(HR:0.67;95%CI;0.55-0.82;p<0.001). Other significant predictors for increased late mortality were age>70, NYHA III-IV, smoking, diabetes, severe renal impairment, peripheral vascular disease, history of cerebrovascular adverse events, chronic lung disease, left main disease, IR, impaired LV function and urgent/emergent cases(Table-3).