Front. Med. 2014, 8(4): 395–398 DOI 10.1007/s11684-014-0374-7
MINI-REVIEW
Contemporary coronary artery bypass grafting David P. Taggart Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
© Higher Education Press and Springer-Verlag Berlin Heidelberg 2014
Abstract Current evidence clearly demonstrates that coronary artery bypass grafting (CABG) remains the “gold standard” treatment for most patients with multivessel and left main stem disease. This article summarizes the relevant evidence basis demonstrating that CABG, in comparison to stenting, reduces mortality and subsequent myocardial infarction and the need for repeat revascularization. The article also describes the evidence basis to support the use of more arterial grafts during CABG and the current role of off-pump CABG. Keywords coronary artery bypass grafting (CABG); coronary artery disease; left main; arterial grafts; internal mammary artery; off-pump CABG
Introduction and background Since its first description in the 1960s coronary artery bypass grafting (CABG) increased dramatically over the following three decades in developed countries. The numbers of CABG operations then gradually decreased with the widespread use of percutaneous coronary intervention (PCI), initially with balloon angioplasty and then with the improving technologies of bare metal and drug eluting stents. In contrast, in many developing countries, and starting from a particularly low base, the number of CABG operations is continuing to increase. Currently there are around 3/4 of million CABG operations performed worldwide each year. For over 20 years there has been considerable controversy over the relative merits of CABG versus stents in terms of patient survival. In an analysis of 15 trials of PCI versus CABG involving around 9000 patients there was no obvious difference in survival between CABG and PCI [1]. However, one of the reasons for this finding was unquestionably because of the nature of the patients enrolled into the trials. Only around 5% of all potentially eligible patients were recruited into the trials and the vast majority of patients actually had single or double vessel disease which did not involve the proximal anterior descending coronary artery [1]. In such a population it was therefore entirely predictable that there would be no
Received August 12, 2014; accepted September 12, 2014 Correspondence: [email protected]
difference in survival between CABG and PCI. However, the findings in these randomized trials were at considerable variation with many registries often containing tens of thousands of patients, propensity matched for baseline characteristics, which showed a significant survival advantage for CABG [2]. The most likely explanation for the different findings between trials and registries is almost certainly because registries enrolled patients taken from everyday clinical practice and who have much more severe coronary disease than those entered into the trials. Whereas trial patients had to be deemed potentially suitable for PCI many patients in registries had disease of such severity that it precluded PCI whereas, in contrast, there are very few patients who are technically ineligible for CABG in trials or registries. In 2014 a very significant body of evidence has now accumulated to show a clear and distinct survival advantage for CABG over PCI as well as marked reductions in myocardial infarction and the need for repeat revascularization. The 5-year analysis of the SYNTAX Trial has now been published for both 3-vessel coronary disease [3] and left main stem disease [4]. For 3-vessel coronary artery disease CABG produces a clear survival advantage of 5.4% at 5 years with marked reductions in myocardial infarction and repeat revascularization and without an increased incidence of stroke [3]. Furthermore, as the severity of coronary artery disease increases, patients with intermediate (23–32) and high ( > 32) SYNTAX scores have respective survival benefits with CABG of 7% and 9% [3]. A recent meta-analysis of contemporary trails of PCI versus CABG in 3-vessel disease that includes the
396
SYNTAX analysis confirms this marked reduction in mortality for patients with CABG in contrast to PCI [5]. Many studies have suggested that the benefits of CABG are further enhanced in patients with diabetes and this has been recently confirmed in the FREEDOM Trial and two independent meta-analysis of CABG versus PCI in patients with diabetes [6,7]. For patients with left main disease the situation is somewhat different. Overall in the analysis of 705 patients from the SYNTAX Trial with left main there was no difference in overall between CABG and PCI [4]. In a subgroup analysis, patients with the lower ( < 23) and intermediate (23–32) SYNTAX scores had a lower mortality and risk of stroke with PCI versus CABG [4]. Indeed, it was only in patients with left main with high SYNTAX scores ( > 32) where there appeared to be a survival advantage of CABG as well as a marked reduction in the need for repeat revascularization. Overall for left main as opposed to 3-vessel disease there was an increased risk of stroke with CABG versus PCI. These findings are almost certainly real because they are entirely consistent with the results of the Precombat Trial, which also showed no significant differences in outcomes in terms of survival or myocardial infarction in left main disease in 600 patients randomized to PCI or CABG [8]. Again, in the Precombat Trial the only advantage of CABG was in reduction in repeat revascularization but additionally there was no increased incidence of stroke with CABG versus PCI. A definitive answer to the optimal mode of revascularization for left main disease will be the Excel and Noble Trials that have either completed or are near to completion of enrolment.
Optimising CABG: arterial grafts and off-pump CABG Two important developments have taken place over the past 30 years with respect to the performance of CABG. In 1986 the Cleveland Clinic reported in a landmark paper the survival benefit of the internal mammary artery (IMA) when placed to the left anterior descending in terms of reducing subsequent death, myocardial infarction, recurrent angina and the need for repeat revascularization [9]. The benefits of the IMA are almost certainly due to its high production of nitric oxide which not only enhances the patency of the IMA but also helps protect the native coronary circulation against the development of further disease [10]. Consequently many authors have investigated the benefits of a second IMA and although there has only been one randomized trial to date, the ART Trial, that has completed recruitment but awaits ten-year outcomes data [11], there is very strong circumstantial evidence of improved survival with a second IMA [12]. More recently, two independent groups produced meta-analyses reporting
Contemporary coronary artery bypass grafting
that in propensity matched patients a second IMA graft resulted in a marked reduction in the hazard ratio for death [13,14]. Furthermore, the preliminary results of the ART Trial showed the use of a second IMA did not increase the risk of death, myocardial infarction, stroke or repeat revascularization at 1 year but did report an increased incidence of sternal wound breakdown but mainly and predominantly in patients with diabetes [11]. Despite strong evidence in favor of a second IMA, fewer than 5% of patients in the USA and fewer than 10% of patients in Europe currently receive this option. With regards to the radial artery, there is now convincing evidence that its patency is superior to that of saphenous veins beyond one year as long as the radial artery is used in patients with at least a 70% stenosis in the native coronary artery [15]. There is now also evidence that the use of a radial artery rather than saphenous vein in addition to an IMA may result in superior long-term survival in comparison to vein grafts [16]. Off pump surgery was introduced into clinical practice in the 1980s and for a while saw a great surge in popularity before there was genuine appreciation of its more challenging technical aspect. This then led to a flurry of publications suggesting that off pump surgery actually resulted in inferior outcomes compared to conventional on pump CABG [17]. However, recently two large randomized trials, the Coronary Trial [18] and the GOPCABGE [19] have both reported that at one year of follow-up there is no difference in any major outcome in terms of mortality, stroke, repeat revascularization or new renal injury between the two techniques. Nevertheless some enthusiasts continue to argue that in higher risk patients there is a significant reduction in all course mortality and stroke with the use of off pump surgery. Two very large propensity matched registries [20,21] have both described similar findings of reduction in mortality and all major aspects of morbidity with off pump surgery. It should also be noted that off pump surgery is probably optimal when it is performed with a true no touch aortic technique which has also been shown to significantly reduce the risk of stroke [22,23].
Summary Today’s best evidence suggests that CABG is definitely a markedly superior revascularization strategy for patients with multi-vessel disease in terms of survival, reduction of myocardial infarction and need for repeat revascularization and without a significant increase in the risk of stroke. In contrast, CABG only has a benefit in most patients with left main disease who are in the higher risk tertiles whereas for lower and intermediate tertiles (mainly ostial or midshaft lesions with perhaps one or two vessel disease) PCI offers similar survival with a lower incidence of stroke but
David P. Taggart
with a higher risk of repeat revascularization. There is now robust and consistent evidence that many patients would benefit from the use of a second internal mammary artery and possibly also a radial artery. For off pump surgery the evidence is conflicting but for most patients there seems to be no obvious benefit over on pump surgery except perhaps in patients in the highest risk categories.
397
8.
9.
Compliance with ethics guidelines David P. Taggart declares that he has no conflict of interest. This manuscript is a mini-review and does not involve a research protocol requiring approval by the relevant institutional review board or ethics committee.
10.
References
11.
1. Taggart DP, Thomas B. Ferguson Lecture. Coronary artery bypass grafting is still the best treatment for multivessel and left main disease, but patients need to know. Ann Thorac Surg 2006; 82(6): 1966–1975 2. Weintraub WS, Grau-Sepulveda MV, Weiss JM, O’Brien SM, Peterson ED, Kolm P, Zhang Z, Klein LW, Shaw RE, McKay C, Ritzenthaler LL, Popma JJ, Messenger JC, Shahian DM, Grover FL, Mayer JE, Shewan CM, Garratt KN, Moussa ID, Dangas GD, Edwards FH. Comparative effectiveness of revascularization strategies. N Engl J Med 2012; 366(16): 1467–1476 3. Head SJ, Davierwala PM, Serruys PW, Redwood SR, Colombo A, Mack MJ, Morice MC, Holmes DR Jr, Feldman TE, Ståhle E, Underwood P, Dawkins KD, Kappetein AP, Mohr FW. Coronary artery bypass grafting vs. percutaneous coronary intervention for patients with three-vessel disease: final five-year follow-up of the SYNTAX trial. Eur Heart J 2014 May 21. [Epub ahead of print] 4. Morice MC, Serruys PW, Kappetein AP, Feldman TE, Ståhle E, Colombo A, Mack MJ, Holmes DR, Choi JW, Ruzyllo W, Religa G, Huang J, Roy K, Dawkins KD, Mohr F. Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the SYNTAX Trial. Circulation 2014; 129(23): 2388–2394 5. Sipahi I, Akay MH, Dagdelen S, Blitz A, Alhan C. Coronary artery bypass grafting vs. percutaneous coronary intervention and longterm mortality and morbidity in multivessel disease: meta-analysis of randomized clinical trials of the arterial grafting and stenting era. JAMA Intern Med 2014; 174(2): 223–230 6. Hakeem A, Garg N, Bhatti S, Rajpurohit N, Ahmed Z, Uretsky BF. Effectiveness of percutaneous coronary intervention with drugeluting stents compared with bypass surgery in diabetics with multivessel coronary disease: comprehensive systematic review and meta-analysis of randomized clinical data. J Am Heart Assoc 2013; 2(4): e000354 7. Verma S, Farkouh ME, Yanagawa B, Fitchett DH, Ahsan MR, Ruel M, Sud S, Gupta M, Singh S, Gupta N, Cheema AN, Leiter LA, Fedak PW, Teoh H, Latter DA, Fuster V, Friedrich JO. Comparison of coronary artery bypass surgery and percutaneous coronary intervention in patients with diabetes: a meta-analysis of randomised
12.
13.
14.
15.
16.
17.
18.
19.
controlled trials. Lancet Diabetes Endocrinol 2013; 1(4): 317– 328 Park SJ, Kim YH, Park DW, Yun SC, Ahn JM, Song HG, Lee JY, Kim WJ, Kang SJ, Lee SW, Lee CW, Park SW, Chung CH, Lee JW, Lim DS, Rha SW, Lee SG, Gwon HC, Kim HS, Chae IH, Jang Y, Jeong MH, Tahk SJ, Seung KB. Randomized trial of stents versus bypass surgery for left main coronary artery disease. N Engl J Med 2011; 364(18): 1718–1727 Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, Golding LA, Gill CC, Taylor PC, Sheldon WC, Proudfit WL. Influence of the internal-mammary-artery graft on 10year survival and other cardiac events. N Engl J Med 1986; 314(1): 1–6 Lüscher TF, Diederich D, Siebenmann R, Lehmann K, Stulz P, von Segesser L, Yang ZH, Turina M, Grädel E, Weber E, et al. Difference between endothelium-dependent relaxation in arterial and in venous coronary bypass grafts. N Engl J Med 1988; 319(8): 462–467 Taggart DP, Altman DG, Gray AM, Lees B, Nugara F, Yu LM, Campbell H, Flather M; ART Investigators. Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART). Eur Heart J 2010; 31(20): 2470–2481 Taggart DP, D’Amico R, Altman DG. Effect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet 2001; 358 (9285): 870–875 Yi G, Shine B, Rehman SM, Altman DG, Taggart DP. Effect of bilateral internal mammary artery grafts on long-term survival: a meta-analysis approach. Circulation 2014; 130(7): 539–545 Weiss AJ, Zhao S, Tian DH, Taggart DP, Yan TD. A meta-analysis comparing bilateral internal mammary artery with left internal mammary artery for coronary artery bypass grafting. Ann Cardiothorac Surg 2013; 2(4): 390–400 Rehman SM, Yi G, Taggart DP. The radial artery: current concepts on its use in coronary artery revascularization. Ann Thorac Surg 2013; 96(5): 1900–1909 Tranbaugh RF, Dimitrova KR, Friedmann P, Geller CM, Harris LJ, Stelzer P, Cohen BM, Ko W, DeCastro H, Lucido D, Hoffman DM. Coronary artery bypass grafting using the radial artery: clinical outcomes, patency, and need for reintervention. Circulation 2012; 126(11 Suppl 1): S170–S175 Møller CH, Penninga L, Wetterslev J, Steinbrüchel DA, Gluud C. Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease. Cochrane Database Syst Rev 2012; 3: CD007224 Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, Straka Z, Piegas LS, Akar AR, Jain AR, Noiseux N, Padmanabhan C, Bahamondes JC, Novick RJ, Vaijyanath P, Reddy SK, Tao L, Olavegogeascoechea PA, Airan B, Sulling TA, Whitlock RP, Ou Y, Pogue J, Chrolavicius S, Yusuf S; CORONARY Investigators. Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. N Engl J Med 2013; 368 (13): 1179–1188 Diegeler A, Börgermann J, Kappert U, Breuer M, Böning A, Ursulescu A, Rastan A, Holzhey D, Treede H, Rieß FC, Veeckmann P, Asfoor A, Reents W, Zacher M, Hilker M; GOPCABE Study Group. Off-pump versus on-pump coronary-artery bypass grafting
398 in elderly patients. N Engl J Med 2013; 368(13): 1189–1198 20. Kuss O, von Salviati B, Börgermann J. Off-pump versus on-pump coronary artery bypass grafting: a systematic review and metaanalysis of propensity score analyses. J Thorac Cardiovasc Surg 2010; 140(4): 829–835, e1–e13 21. Polomsky M, He X, O’Brien SM, Puskas JD. Outcomes of off-pump versus on-pump coronary artery bypass grafting: Impact of preoperative risk. J Thorac Cardiovasc Surg 2013; 145(5): 1193– 1198
Contemporary coronary artery bypass grafting 22. Börgermann J, Hakim K, Renner A, Parsa A, Aboud A, Becker T, Masshoff M, Zittermann A, Gummert JF, Kuss O. Clampless offpump versus conventional coronary artery revascularization: a propensity score analysis of 788 patients. Circulation 2012; 126(11 Suppl 1): S176–S182 23. Misfeld M, Brereton RJ, Sweetman EA, Doig GS. Neurologic complications after off-pump coronary artery bypass grafting with and without aortic manipulation: meta-analysis of 11,398 cases from 8 studies. J Thorac Cardiovasc Surg 2011; 142(2): e11–e17
MINI-REVIEW
Contemporary coronary artery bypass grafting David P. Taggart Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
© Higher Education Press and Springer-Verlag Berlin Heidelberg 2014
Abstract Current evidence clearly demonstrates that coronary artery bypass grafting (CABG) remains the “gold standard” treatment for most patients with multivessel and left main stem disease. This article summarizes the relevant evidence basis demonstrating that CABG, in comparison to stenting, reduces mortality and subsequent myocardial infarction and the need for repeat revascularization. The article also describes the evidence basis to support the use of more arterial grafts during CABG and the current role of off-pump CABG. Keywords coronary artery bypass grafting (CABG); coronary artery disease; left main; arterial grafts; internal mammary artery; off-pump CABG
Introduction and background Since its first description in the 1960s coronary artery bypass grafting (CABG) increased dramatically over the following three decades in developed countries. The numbers of CABG operations then gradually decreased with the widespread use of percutaneous coronary intervention (PCI), initially with balloon angioplasty and then with the improving technologies of bare metal and drug eluting stents. In contrast, in many developing countries, and starting from a particularly low base, the number of CABG operations is continuing to increase. Currently there are around 3/4 of million CABG operations performed worldwide each year. For over 20 years there has been considerable controversy over the relative merits of CABG versus stents in terms of patient survival. In an analysis of 15 trials of PCI versus CABG involving around 9000 patients there was no obvious difference in survival between CABG and PCI [1]. However, one of the reasons for this finding was unquestionably because of the nature of the patients enrolled into the trials. Only around 5% of all potentially eligible patients were recruited into the trials and the vast majority of patients actually had single or double vessel disease which did not involve the proximal anterior descending coronary artery [1]. In such a population it was therefore entirely predictable that there would be no
Received August 12, 2014; accepted September 12, 2014 Correspondence: [email protected]
difference in survival between CABG and PCI. However, the findings in these randomized trials were at considerable variation with many registries often containing tens of thousands of patients, propensity matched for baseline characteristics, which showed a significant survival advantage for CABG [2]. The most likely explanation for the different findings between trials and registries is almost certainly because registries enrolled patients taken from everyday clinical practice and who have much more severe coronary disease than those entered into the trials. Whereas trial patients had to be deemed potentially suitable for PCI many patients in registries had disease of such severity that it precluded PCI whereas, in contrast, there are very few patients who are technically ineligible for CABG in trials or registries. In 2014 a very significant body of evidence has now accumulated to show a clear and distinct survival advantage for CABG over PCI as well as marked reductions in myocardial infarction and the need for repeat revascularization. The 5-year analysis of the SYNTAX Trial has now been published for both 3-vessel coronary disease [3] and left main stem disease [4]. For 3-vessel coronary artery disease CABG produces a clear survival advantage of 5.4% at 5 years with marked reductions in myocardial infarction and repeat revascularization and without an increased incidence of stroke [3]. Furthermore, as the severity of coronary artery disease increases, patients with intermediate (23–32) and high ( > 32) SYNTAX scores have respective survival benefits with CABG of 7% and 9% [3]. A recent meta-analysis of contemporary trails of PCI versus CABG in 3-vessel disease that includes the
396
SYNTAX analysis confirms this marked reduction in mortality for patients with CABG in contrast to PCI [5]. Many studies have suggested that the benefits of CABG are further enhanced in patients with diabetes and this has been recently confirmed in the FREEDOM Trial and two independent meta-analysis of CABG versus PCI in patients with diabetes [6,7]. For patients with left main disease the situation is somewhat different. Overall in the analysis of 705 patients from the SYNTAX Trial with left main there was no difference in overall between CABG and PCI [4]. In a subgroup analysis, patients with the lower ( < 23) and intermediate (23–32) SYNTAX scores had a lower mortality and risk of stroke with PCI versus CABG [4]. Indeed, it was only in patients with left main with high SYNTAX scores ( > 32) where there appeared to be a survival advantage of CABG as well as a marked reduction in the need for repeat revascularization. Overall for left main as opposed to 3-vessel disease there was an increased risk of stroke with CABG versus PCI. These findings are almost certainly real because they are entirely consistent with the results of the Precombat Trial, which also showed no significant differences in outcomes in terms of survival or myocardial infarction in left main disease in 600 patients randomized to PCI or CABG [8]. Again, in the Precombat Trial the only advantage of CABG was in reduction in repeat revascularization but additionally there was no increased incidence of stroke with CABG versus PCI. A definitive answer to the optimal mode of revascularization for left main disease will be the Excel and Noble Trials that have either completed or are near to completion of enrolment.
Optimising CABG: arterial grafts and off-pump CABG Two important developments have taken place over the past 30 years with respect to the performance of CABG. In 1986 the Cleveland Clinic reported in a landmark paper the survival benefit of the internal mammary artery (IMA) when placed to the left anterior descending in terms of reducing subsequent death, myocardial infarction, recurrent angina and the need for repeat revascularization [9]. The benefits of the IMA are almost certainly due to its high production of nitric oxide which not only enhances the patency of the IMA but also helps protect the native coronary circulation against the development of further disease [10]. Consequently many authors have investigated the benefits of a second IMA and although there has only been one randomized trial to date, the ART Trial, that has completed recruitment but awaits ten-year outcomes data [11], there is very strong circumstantial evidence of improved survival with a second IMA [12]. More recently, two independent groups produced meta-analyses reporting
Contemporary coronary artery bypass grafting
that in propensity matched patients a second IMA graft resulted in a marked reduction in the hazard ratio for death [13,14]. Furthermore, the preliminary results of the ART Trial showed the use of a second IMA did not increase the risk of death, myocardial infarction, stroke or repeat revascularization at 1 year but did report an increased incidence of sternal wound breakdown but mainly and predominantly in patients with diabetes [11]. Despite strong evidence in favor of a second IMA, fewer than 5% of patients in the USA and fewer than 10% of patients in Europe currently receive this option. With regards to the radial artery, there is now convincing evidence that its patency is superior to that of saphenous veins beyond one year as long as the radial artery is used in patients with at least a 70% stenosis in the native coronary artery [15]. There is now also evidence that the use of a radial artery rather than saphenous vein in addition to an IMA may result in superior long-term survival in comparison to vein grafts [16]. Off pump surgery was introduced into clinical practice in the 1980s and for a while saw a great surge in popularity before there was genuine appreciation of its more challenging technical aspect. This then led to a flurry of publications suggesting that off pump surgery actually resulted in inferior outcomes compared to conventional on pump CABG [17]. However, recently two large randomized trials, the Coronary Trial [18] and the GOPCABGE [19] have both reported that at one year of follow-up there is no difference in any major outcome in terms of mortality, stroke, repeat revascularization or new renal injury between the two techniques. Nevertheless some enthusiasts continue to argue that in higher risk patients there is a significant reduction in all course mortality and stroke with the use of off pump surgery. Two very large propensity matched registries [20,21] have both described similar findings of reduction in mortality and all major aspects of morbidity with off pump surgery. It should also be noted that off pump surgery is probably optimal when it is performed with a true no touch aortic technique which has also been shown to significantly reduce the risk of stroke [22,23].
Summary Today’s best evidence suggests that CABG is definitely a markedly superior revascularization strategy for patients with multi-vessel disease in terms of survival, reduction of myocardial infarction and need for repeat revascularization and without a significant increase in the risk of stroke. In contrast, CABG only has a benefit in most patients with left main disease who are in the higher risk tertiles whereas for lower and intermediate tertiles (mainly ostial or midshaft lesions with perhaps one or two vessel disease) PCI offers similar survival with a lower incidence of stroke but
David P. Taggart
with a higher risk of repeat revascularization. There is now robust and consistent evidence that many patients would benefit from the use of a second internal mammary artery and possibly also a radial artery. For off pump surgery the evidence is conflicting but for most patients there seems to be no obvious benefit over on pump surgery except perhaps in patients in the highest risk categories.
397
8.
9.
Compliance with ethics guidelines David P. Taggart declares that he has no conflict of interest. This manuscript is a mini-review and does not involve a research protocol requiring approval by the relevant institutional review board or ethics committee.
10.
References
11.
1. Taggart DP, Thomas B. Ferguson Lecture. Coronary artery bypass grafting is still the best treatment for multivessel and left main disease, but patients need to know. Ann Thorac Surg 2006; 82(6): 1966–1975 2. Weintraub WS, Grau-Sepulveda MV, Weiss JM, O’Brien SM, Peterson ED, Kolm P, Zhang Z, Klein LW, Shaw RE, McKay C, Ritzenthaler LL, Popma JJ, Messenger JC, Shahian DM, Grover FL, Mayer JE, Shewan CM, Garratt KN, Moussa ID, Dangas GD, Edwards FH. Comparative effectiveness of revascularization strategies. N Engl J Med 2012; 366(16): 1467–1476 3. Head SJ, Davierwala PM, Serruys PW, Redwood SR, Colombo A, Mack MJ, Morice MC, Holmes DR Jr, Feldman TE, Ståhle E, Underwood P, Dawkins KD, Kappetein AP, Mohr FW. Coronary artery bypass grafting vs. percutaneous coronary intervention for patients with three-vessel disease: final five-year follow-up of the SYNTAX trial. Eur Heart J 2014 May 21. [Epub ahead of print] 4. Morice MC, Serruys PW, Kappetein AP, Feldman TE, Ståhle E, Colombo A, Mack MJ, Holmes DR, Choi JW, Ruzyllo W, Religa G, Huang J, Roy K, Dawkins KD, Mohr F. Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the SYNTAX Trial. Circulation 2014; 129(23): 2388–2394 5. Sipahi I, Akay MH, Dagdelen S, Blitz A, Alhan C. Coronary artery bypass grafting vs. percutaneous coronary intervention and longterm mortality and morbidity in multivessel disease: meta-analysis of randomized clinical trials of the arterial grafting and stenting era. JAMA Intern Med 2014; 174(2): 223–230 6. Hakeem A, Garg N, Bhatti S, Rajpurohit N, Ahmed Z, Uretsky BF. Effectiveness of percutaneous coronary intervention with drugeluting stents compared with bypass surgery in diabetics with multivessel coronary disease: comprehensive systematic review and meta-analysis of randomized clinical data. J Am Heart Assoc 2013; 2(4): e000354 7. Verma S, Farkouh ME, Yanagawa B, Fitchett DH, Ahsan MR, Ruel M, Sud S, Gupta M, Singh S, Gupta N, Cheema AN, Leiter LA, Fedak PW, Teoh H, Latter DA, Fuster V, Friedrich JO. Comparison of coronary artery bypass surgery and percutaneous coronary intervention in patients with diabetes: a meta-analysis of randomised
12.
13.
14.
15.
16.
17.
18.
19.
controlled trials. Lancet Diabetes Endocrinol 2013; 1(4): 317– 328 Park SJ, Kim YH, Park DW, Yun SC, Ahn JM, Song HG, Lee JY, Kim WJ, Kang SJ, Lee SW, Lee CW, Park SW, Chung CH, Lee JW, Lim DS, Rha SW, Lee SG, Gwon HC, Kim HS, Chae IH, Jang Y, Jeong MH, Tahk SJ, Seung KB. Randomized trial of stents versus bypass surgery for left main coronary artery disease. N Engl J Med 2011; 364(18): 1718–1727 Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, Golding LA, Gill CC, Taylor PC, Sheldon WC, Proudfit WL. Influence of the internal-mammary-artery graft on 10year survival and other cardiac events. N Engl J Med 1986; 314(1): 1–6 Lüscher TF, Diederich D, Siebenmann R, Lehmann K, Stulz P, von Segesser L, Yang ZH, Turina M, Grädel E, Weber E, et al. Difference between endothelium-dependent relaxation in arterial and in venous coronary bypass grafts. N Engl J Med 1988; 319(8): 462–467 Taggart DP, Altman DG, Gray AM, Lees B, Nugara F, Yu LM, Campbell H, Flather M; ART Investigators. Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART). Eur Heart J 2010; 31(20): 2470–2481 Taggart DP, D’Amico R, Altman DG. Effect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet 2001; 358 (9285): 870–875 Yi G, Shine B, Rehman SM, Altman DG, Taggart DP. Effect of bilateral internal mammary artery grafts on long-term survival: a meta-analysis approach. Circulation 2014; 130(7): 539–545 Weiss AJ, Zhao S, Tian DH, Taggart DP, Yan TD. A meta-analysis comparing bilateral internal mammary artery with left internal mammary artery for coronary artery bypass grafting. Ann Cardiothorac Surg 2013; 2(4): 390–400 Rehman SM, Yi G, Taggart DP. The radial artery: current concepts on its use in coronary artery revascularization. Ann Thorac Surg 2013; 96(5): 1900–1909 Tranbaugh RF, Dimitrova KR, Friedmann P, Geller CM, Harris LJ, Stelzer P, Cohen BM, Ko W, DeCastro H, Lucido D, Hoffman DM. Coronary artery bypass grafting using the radial artery: clinical outcomes, patency, and need for reintervention. Circulation 2012; 126(11 Suppl 1): S170–S175 Møller CH, Penninga L, Wetterslev J, Steinbrüchel DA, Gluud C. Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease. Cochrane Database Syst Rev 2012; 3: CD007224 Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, Straka Z, Piegas LS, Akar AR, Jain AR, Noiseux N, Padmanabhan C, Bahamondes JC, Novick RJ, Vaijyanath P, Reddy SK, Tao L, Olavegogeascoechea PA, Airan B, Sulling TA, Whitlock RP, Ou Y, Pogue J, Chrolavicius S, Yusuf S; CORONARY Investigators. Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. N Engl J Med 2013; 368 (13): 1179–1188 Diegeler A, Börgermann J, Kappert U, Breuer M, Böning A, Ursulescu A, Rastan A, Holzhey D, Treede H, Rieß FC, Veeckmann P, Asfoor A, Reents W, Zacher M, Hilker M; GOPCABE Study Group. Off-pump versus on-pump coronary-artery bypass grafting
398 in elderly patients. N Engl J Med 2013; 368(13): 1189–1198 20. Kuss O, von Salviati B, Börgermann J. Off-pump versus on-pump coronary artery bypass grafting: a systematic review and metaanalysis of propensity score analyses. J Thorac Cardiovasc Surg 2010; 140(4): 829–835, e1–e13 21. Polomsky M, He X, O’Brien SM, Puskas JD. Outcomes of off-pump versus on-pump coronary artery bypass grafting: Impact of preoperative risk. J Thorac Cardiovasc Surg 2013; 145(5): 1193– 1198
Contemporary coronary artery bypass grafting 22. Börgermann J, Hakim K, Renner A, Parsa A, Aboud A, Becker T, Masshoff M, Zittermann A, Gummert JF, Kuss O. Clampless offpump versus conventional coronary artery revascularization: a propensity score analysis of 788 patients. Circulation 2012; 126(11 Suppl 1): S176–S182 23. Misfeld M, Brereton RJ, Sweetman EA, Doig GS. Neurologic complications after off-pump coronary artery bypass grafting with and without aortic manipulation: meta-analysis of 11,398 cases from 8 studies. J Thorac Cardiovasc Surg 2011; 142(2): e11–e17
