ArticleThe Canadian journal of cardiology2026
Reevaluating Internal Thoracic Artery Use in Octogenarians Undergoing Multivessel Coronary Artery Bypass Grafting.
Article in The Canadian journal of cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundInternal thoracic artery (ITA) use is a benchmark of quality in coronary artery bypass grafting (CABG), yet its value in contemporary practice among octogenarians remains uncertain. We compared mid-term major adverse cardiac events and all-cause mortality among octogenarians undergoing CABG with ITA plus saphenous vein grafts (SVGs) vs SVG-only.
methodsWe identified 13,925 octogenarians who underwent isolated first-time elective CABG with 2-4 grafts from 2015 to 2022 in the US Centers for Medicare and Medicaid database validated against individual clinical records: 12,280 received ITA+SVG and 1105 received SVG-only. The primary outcome was 6-year freedom from major adverse cardiac events (MACE) defined as death, myocardial infarction, or repeated revascularisation. The secondary outcome was 6-year all-cause mortality. Median follow-up time was 4.3 years (interquartile range [IQR] 4.2-4.5 years). Outcomes were compared in a Cox proportional hazards model after propensity matching across 28 covariates with an exact number of grafts.
resultsPatients receiving ITA+SVG were of similar age (81 years [IQR 80-83 years] vs 82 years [IQR 80-84 years]; P = 0.13) and less often female (24% vs 31.1%; P < 0.001). Propensity score matching yielded 1101 well matched pairs. Six-year freedom from MACE was 49.7% in the ITA+SVG group vs 48% in the SVG-only group (adjusted hazard ratio [aHR] 0.92, 95% confidence interval [CI] 0.79-1.06; P = 0.23). There was no difference in 6-year all-cause mortality (54.8% vs 52.7%; aHR 0.90, 95% CI 0.78-1.05; P = 0.19).
conclusionsAmong octogenarians undergoing elective multivessel CABG, ITA use was not associated with improved 6-year freedom from MACE or all-cause mortality. These findings suggest that universal ITA-based quality metrics may need reassessment for octogenarians.
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