J.Jpn. Surg. Soc.. 97(3): 202-209, 1996

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Feature topic

TEN-YEAR SURVIVAL AND CARDIAC EVENT-FREE RATES IN JAPANESE PATIENTS WITH THE LEFT ANTERIOR DESCENDING ARTERY REVASCULARIZED WITH INTERNAL THORACIC ARTERY OR SAPHENOUS VEIN GRAFT : A COMPARATIVE STUDY

To evaluate the long-term results of surgical patients with coronary artery bypass grafting (CABG), we comparatively analyzed the 10-year survival and cardiac event-free rates between 713 patients group with at least one internal thoracic artery to the Ieft anterior descending artery (LAD), (ITA-CABG) and 241 patients group revascularized with vein grafts alone (SVG-CABG).
ITA-CABG patients had more progressed diseases with a higher incidence of risk factors than SVG-CABG patients : number of vessel diseased 2.5±0.7 vs 2.3±0.7, LMTD 20.2％ vs 14.1％, diabetes mellitus 37.3％ vs 27.0％ and hyperlipidemia 38.0％ vs 30.7％. The 10-year cumulative LAD graft patency and severe disease-free rate was 90.3 and 67.0％ for ITAs and vein grafts in this series.
The 10-year overall actuarial survival, cardiac death-free and cardiac event-free rates for ITA and SVG groups were 88.8 vs 79.5％, 97.4 vs 92.6％ and 84.1 vs 73.1％, all with astatistical significance (generalized Wilcoxon or logrank method). For the patients with reduced ventricular systolic function (EF≦0.4), ITA-CABG offered a significantly better 10-year cardiac death free rate. Also, for the diabetic patients, ITA-LAD offered a significantly better 10-year cardiac event-free rate.
In conclusion, the use of ITA graft can reduce postoperative cardiac events and enhance the longterm survival in Japanese patients. The ITA should be utilized at least for LAD in all CABG patients whenever feasible.

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