Bilateral versus single internal thoracic coronary artery bypass grafting: the ART RCT
Why the study?
It remains debated whether using more arterial grafts during coronary artery bypass graft surgery provides advantages over the standard operation using the left internal thoracic artery plus vein grafts.
Does bilateral internal thoracic artery grafting reduce all-cause mortality at 10 years compared to single internal thoracic artery grafting in patients undergoing coronary artery bypass graft surgery?
Population
3102 patients undergoing coronary artery bypass graft for clinical reasons
Comparison
Bilateral internal thoracic arteries vs single internal thoracic artery
Design
Randomized controlled trial
Follow-up
10 years
Authors
Discussion
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Member takes
Implication
No 10-year mortality benefit with BITA versus SITA grafting; confirms single ITA as standard in CABG.
Structured PICO
Does bilateral internal thoracic artery grafting reduce all-cause mortality at 10 years compared to single internal thoracic artery grafting in patients undergoing coronary artery bypass graft surgery?
P
Population
3,102 patients undergoing coronary artery bypass graft for clinical reasons
I
Intervention
Bilateral internal thoracic artery grafting (additional vein grafts could be used)
C
Comparator
Standard coronary artery bypass graft using the single internal thoracic artery (additional vein grafts could be used)
O
Outcome
All-cause mortality at 10 yearshard clinical
Bilateral internal thoracic artery grafting did not significantly reduce 10-year all-cause mortality compared to single internal thoracic artery grafting, though high crossover rates may have diluted potential benefits.
Limitations
- Elevated cross-over rate between bilateral internal thoracic artery and single internal thoracic artery
- Non-randomised use of radial artery grafts may have contributed to a loss of power
- Secondary analyses are prone to bias as they compare non-randomised groups
Cite This Study
Flather et al. (2023) studied this question.