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Eur J Cardiothorac Surg 2002;22:781-786
© 2002 Elsevier Science NL
a Istituto Chirurgia Cardiovascolare, Università di Padova, FETCS, Istituto Chirurgia Cardiovascolare, Via Giustiniani 2, 35128 Padova, Italy
b Dipartimento di Scienze Statistiche, Università di Padova, Padova, Italy
Received 8 May 2002; received in revised form 21 July 2002; accepted 30 July 2002.
* Corresponding author. Tel.: +39-49-821-2408; fax: +39-49-821-2409
e-mail: giulio.rizzoli{at}unipd.it
Objectives: Does the use of bilateral internal mammary artery (IMA) grafts provide incremental benefit relative to the use of a single IMA graft? Methods: Meta-analysis by qualitative and quantitative protocol of the studies published in the literature in the last 15 years. Only eight, out of 149 observational studies found, met our criteria: surgical results of bilateral versus single IMA, patient age range from 20 to 89 years, exclusion of emergency and diabetic patients, study group larger than 100 patients, minimal follow-up time. The final sample size included 16 362 patients. Results: Late survival was evaluated at 5 and 10 years. The hazard ratio (HR) was calculated from seven studies, the difference of survival was from six and five studies, respectively. The effect size was summarized using a random effect model, suggested by the results of statistical test for homogeneity of the HR (P<0.05) and of the survival difference at 5 (P<0.05) and at 10 years (P<0.05). The bilateral IMA estimate of combined HR was 0.79 (95% confidence limits, C.L.=0.66÷0.91). The combined difference of survival probability at 5 years was 0.014 (95% C.L.=-0.03÷0.06) and at 10 years was 0.07 (95% C.L.=0.003÷0.170). Conclusion: There is significant evidence in favor of decreasing death risk of bilateral versus single IMA procedure.
Key Words: Meta-analysis • Coronary artery bypass methods • Thoracic artery • Survival analysis
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