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Editorial
. 2021 Nov 20:9:106-111.
doi: 10.1016/j.xjon.2021.11.008. eCollection 2022 Mar.

The magnitude of the survival benefit of internal thoracic artery grafting: Absolute risk reduction

Takayuki Ohno  1
Affiliations
Editorial

The magnitude of the survival benefit of internal thoracic artery grafting: Absolute risk reduction

Takayuki Ohno. JTCVS Open. .

Abstract

The magnitude of the survival benefit of CABG with internal thoracic artery graft increases with time over decades.

Keywords: CABG; ITA; absolute risk reduction; all-cause death; myocardial infarction; number needed to treat; treatment effect.

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Figures

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Graphical abstract
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Because death is inevitable for all humans, the survival benefits of CABG will eventually disappear. Although this is a conceptual survival curve, the survival benefit of ITA grafting increases the benefit in terms of survival over decades. The expected absolute risk reduction (ARR) of all-cause death by CABG with internal thoracic artery graft and consequent number needed to treat (NNT) are shown.
Figure 1
Figure 1
Number needed to treat (NNT) of coronary artery bypass grafting (CABG) to prevent 1 death across landmark trials in patients with coronary artery disease.,,, The coronary artery diseases for which CABG has a significant prognostic effect are diabetic multivessel disease, low ejection fraction (EF), and 3-vessel disease (3VD). Despite advances in drug therapies such as statins and percutaneous coronary intervention (PCI) devices (bare-metal stents [BMS], drug-eluting stents [DES]), the magnitude of the survival benefit of CABG using the internal thoracic artery (ITA) compared with the era of SVG is greater at 10 years. This might be in part because of the more recent use of multiple arterial grafting and bilateral ITA grafting in CABG. SVG, Saphenous vein graft; FREEDOM, Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease; STICH, Surgical Treatment for Ischemic Heart Failure; SYNTAX, SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery.
Figure 2
Figure 2
Absolute risk reduction (ARR) of all-cause death for saphenous vein coronary artery bypass and consequent number needed to treat (NNT) in the meta-analysis from Yusuf and colleagues. In the era of SVG, coronary artery bypass grafting (CABG) reduced all-cause mortality by 5.6% at 5 years, 5.9% at 7 years, and 4.1% at 10 years. The magnitude of the survival benefit was greatest at approximately 7 years postoperatively, then decreased, and by 12 years, the effect had disappeared. SVG, Saphenous vein graft.
Figure 3
Figure 3
Summary of the magnitude of the survival benefit of internal thoracic artery grafting. CABG, Coronary artery bypass grafting; ITA, internal thoracic artery; FREEDOM, Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease; STICH, Surgical Treatment for Ischemic Heart Failure; SYNTAX, SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery; EXCEL, Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization trial; ARR, absolute risk reduction; NTT, Number Needed to Treat.
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References

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