Clinical implications of internal mammary artery bypass grafts: The Coronary Artery Surgery Study experience

Abstract

From the Coronary Artery Surgery Study Registry, all patients undergoing initial bypass surgery procedures with independent vein grafts were identified. The 950 patients receiving an internal mammary artery bypass graft were compared with the 6027 patients receiving vein graft alone. Improved survival rates with internal mammary artery bypass grafts were noted at hospitals in which these grafts were performed infrequently as well as those in which the internal mammary artery bypass graft was used frequently. The improved survival was noted in patients with normal (p = .004) as well as impaired (p = .004) ventricular function, in men (p = .0001) as well as in women (p = .005), in patients over age 65 (p = .01) as well as younger patients (p < .0001), and in those with (p = .05) or without (p < .0001) critical stenosis of the left main coronary artery. The internal mammary artery bypass graft was an independent predictor of survival (p = .0004) and reduced the risk of dying by a factor of 0.64. It was concluded that the internal mammary artery bypass graft is the bypass vessel of choice and should not be denied any subgroup.