Sequential Grafting of the Left Internal Thoracic Artery to the Left Anterior Descending Artery and Graft Failure

Abstract

Background

There is concern that left internal thoracic artery (LITA)–to diagonal (D)–to left anterior descending artery (LAD) grafts may be more susceptible to failure compared with single LITA-LAD grafts.

Methods

Pooled individual patient data from 8 clinical trials with systematic graft imaging were analyzed to assess the incidence of sequential LITA-D-LAD vs single LITA-LAD grafts. Mixed-effects multivariable logistic regression, adjusting for patient characteristics and clustering within trials, was used.

Results

Of 3969 patients with LITA-LAD grafts, 283 patients (7.1%) received sequential LITA-D-LAD grafts. Patients with sequential LITA-D-LAD grafts were older (66 vs 65 years, P = .009) and more often men (88% vs 83%, P = .03). Overall, graft failure occurred in 9.3% of patients with LITA-LAD grafts, with more graft failure occurring in single (9.5%) than in sequential LITA-D-LAD grafts (6.4%, P = .08) at a median time to imaging of 1.0 years (interquartile range, 1.0-1.1 years). After multivariable adjustment, sequential LITA-D-LAD grafting was not associated with graft failure (adjusted odds ratio, 1.22; 95% CI, 0.68-2.18; P = .55). There was no difference between groups in mortality (2.8% vs 5.3%, P = .06), myocardial infarction (1.4% vs 1.6%, P = .90), revascularization (4.5% vs 7.3%, P = .08), or stroke (1.7% vs 1.2%, P = .40).

Conclusions

In selected patients, LITA-D-LAD grafting was not associated with higher risk of graft failure or adverse clinical events at 1 year.