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Clinical evaluation of single versus multiple mammary artery bypass.

Publication ,  Journal Article
Morris, JJ; Smith, LR; Glower, DD; Muhlbaier, LH; Reves, JG; Wechsler, AS; Rankin, JS
Published in: Circulation
November 1990

The superior patency and clinical advantages of internal mammary artery (IMA) grafting are well established. However, the relative benefits of routine multiple IMA grafting remain uncertain. To determine whether routine multiple compared with single IMA utilization improved survival of patients undergoing coronary bypass procedures, 1,063 patients were prospectively allocated, beginning in 1984, to divergent management strategies of single (group 1, n = 420) versus multiple IMA grafting (group 2, n = 643). Subsequent analysis of anatomical extent of disease and preoperative baseline risk factors showed no differences (p = NS) between the two groups. All variables reflecting operative technique were similar (p = NS) for the two groups, except 74% of group 1 patients with multivessel disease received a single IMA graft, whereas 71% of group 2 patients with multivessel disease received multiple IMAs (p less than 0.05). By multivariate analysis, impairment of left ventricular ejection fraction, acute evolving myocardial infarction, advanced age, and unstable angina were incremental risk factors for mortality (all p less than 0.03), but group assignment (p = 0.4) and ultimate therapy were not (p = 0.6). Survival probabilities (expressed as 30-day group 1/group 2; 4-year group 1/group 2) were overall (0.97/0.98; 0.93/0.90), elective (0.98/0.99; 0.97/0.92), acute (0.95/0.97; 0.89/0.88), age of less than 65 years (0.98/0.99; 0.97/0.93), age of 65 years or older (0.93/0.97; 0.84/0.89), ejection fraction of 0.40 or more (0.97/0.99; 0.95/0.94), ejection fraction of less than 0.40 (0.95/0.96; 0.87/0.82), nondiabetic (0.98/0.98; 0.94/0.91), and diabetic (0.92/0.97; 0.88/0.87). No differences in survival were significant (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Duke Scholars

Published In

Circulation

ISSN

0009-7322

Publication Date

November 1990

Volume

82

Issue

5 Suppl

Start / End Page

IV214 / IV223

Location

United States

Related Subject Headings

  • Time Factors
  • Survival Rate
  • Survival Analysis
  • Risk Factors
  • Prospective Studies
  • Multivariate Analysis
  • Middle Aged
  • Internal Mammary-Coronary Artery Anastomosis
  • Humans
  • Follow-Up Studies
 

Citation

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Morris, J. J., Smith, L. R., Glower, D. D., Muhlbaier, L. H., Reves, J. G., Wechsler, A. S., & Rankin, J. S. (1990). Clinical evaluation of single versus multiple mammary artery bypass. Circulation, 82(5 Suppl), IV214–IV223.
Morris, J. J., L. R. Smith, D. D. Glower, L. H. Muhlbaier, J. G. Reves, A. S. Wechsler, and J. S. Rankin. “Clinical evaluation of single versus multiple mammary artery bypass.Circulation 82, no. 5 Suppl (November 1990): IV214–23.
Morris JJ, Smith LR, Glower DD, Muhlbaier LH, Reves JG, Wechsler AS, et al. Clinical evaluation of single versus multiple mammary artery bypass. Circulation. 1990 Nov;82(5 Suppl):IV214–23.
Morris, J. J., et al. “Clinical evaluation of single versus multiple mammary artery bypass.Circulation, vol. 82, no. 5 Suppl, Nov. 1990, pp. IV214–23.
Morris JJ, Smith LR, Glower DD, Muhlbaier LH, Reves JG, Wechsler AS, Rankin JS. Clinical evaluation of single versus multiple mammary artery bypass. Circulation. 1990 Nov;82(5 Suppl):IV214–IV223.

Published In

Circulation

ISSN

0009-7322

Publication Date

November 1990

Volume

82

Issue

5 Suppl

Start / End Page

IV214 / IV223

Location

United States

Related Subject Headings

  • Time Factors
  • Survival Rate
  • Survival Analysis
  • Risk Factors
  • Prospective Studies
  • Multivariate Analysis
  • Middle Aged
  • Internal Mammary-Coronary Artery Anastomosis
  • Humans
  • Follow-Up Studies