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Disagreement Between Randomized and Observational Evidence on the Use of Bilateral Internal Thoracic Artery Grafting: A Meta‐Analytic Approach

BACKGROUND: The ART (Arterial Revascularization Trial) showed no difference in survival at 10 years between patients assigned to the single versus bilateral internal thoracic artery grafting strategies. This finding is in contrast with the results of most observational studies, where the use of 2 in...

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Autores principales: Gaudino, Mario, Rahouma, Mohamed, Hameed, Irbaz, Khan, Faiza M., Taggart, David P., Flather, Marcus, Biondi‐Zoccai, Giuseppe, Fremes, Stephen E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912987/
https://www.ncbi.nlm.nih.gov/pubmed/31752642
http://dx.doi.org/10.1161/JAHA.119.014638
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author Gaudino, Mario
Rahouma, Mohamed
Hameed, Irbaz
Khan, Faiza M.
Taggart, David P.
Flather, Marcus
Biondi‐Zoccai, Giuseppe
Fremes, Stephen E.
author_facet Gaudino, Mario
Rahouma, Mohamed
Hameed, Irbaz
Khan, Faiza M.
Taggart, David P.
Flather, Marcus
Biondi‐Zoccai, Giuseppe
Fremes, Stephen E.
author_sort Gaudino, Mario
collection PubMed
description BACKGROUND: The ART (Arterial Revascularization Trial) showed no difference in survival at 10 years between patients assigned to the single versus bilateral internal thoracic artery grafting strategies. This finding is in contrast with the results of most observational studies, where the use of 2 internal thoracic arteries has been associated with improved survival. METHODS AND RESULTS: We selected propensity‐matched studies from the most comprehensive observational meta‐analysis on the long‐term outcomes of patients receiving 1 versus 2 internal thoracic arteries. Individual participant survival data from each study and the ART were reconstructed using an iterative algorithm that was applied to solve the Kaplan‐Meier equations. The reconstructed individual participant survival data were aggregated to obtain combined survival curves and Cox regression hazard ratios with 95% CIs. Individual participant survival data were obtained from 14 matched observational studies (24 123 patients) and the ART. The 10‐year survival of the control group of ART was significantly higher than that of the matched observational studies (hazard ratio, 0.86; 95% CI, 0.80–0.93). The 10‐year survival of the experimental group of ART was significantly lower than that of the bilateral internal thoracic artery group of the observational studies (hazard ratio, 1.11; 95% CI, 1.03–1.20). CONCLUSIONS: Both the improved outcome of the control arm and the lower beneficial effect of the intervention had played a role in the difference between observational evidence and ART.
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spelling pubmed-69129872019-12-23 Disagreement Between Randomized and Observational Evidence on the Use of Bilateral Internal Thoracic Artery Grafting: A Meta‐Analytic Approach Gaudino, Mario Rahouma, Mohamed Hameed, Irbaz Khan, Faiza M. Taggart, David P. Flather, Marcus Biondi‐Zoccai, Giuseppe Fremes, Stephen E. J Am Heart Assoc Brief Communication BACKGROUND: The ART (Arterial Revascularization Trial) showed no difference in survival at 10 years between patients assigned to the single versus bilateral internal thoracic artery grafting strategies. This finding is in contrast with the results of most observational studies, where the use of 2 internal thoracic arteries has been associated with improved survival. METHODS AND RESULTS: We selected propensity‐matched studies from the most comprehensive observational meta‐analysis on the long‐term outcomes of patients receiving 1 versus 2 internal thoracic arteries. Individual participant survival data from each study and the ART were reconstructed using an iterative algorithm that was applied to solve the Kaplan‐Meier equations. The reconstructed individual participant survival data were aggregated to obtain combined survival curves and Cox regression hazard ratios with 95% CIs. Individual participant survival data were obtained from 14 matched observational studies (24 123 patients) and the ART. The 10‐year survival of the control group of ART was significantly higher than that of the matched observational studies (hazard ratio, 0.86; 95% CI, 0.80–0.93). The 10‐year survival of the experimental group of ART was significantly lower than that of the bilateral internal thoracic artery group of the observational studies (hazard ratio, 1.11; 95% CI, 1.03–1.20). CONCLUSIONS: Both the improved outcome of the control arm and the lower beneficial effect of the intervention had played a role in the difference between observational evidence and ART. John Wiley and Sons Inc. 2019-11-22 /pmc/articles/PMC6912987/ /pubmed/31752642 http://dx.doi.org/10.1161/JAHA.119.014638 Text en © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Brief Communication
Gaudino, Mario
Rahouma, Mohamed
Hameed, Irbaz
Khan, Faiza M.
Taggart, David P.
Flather, Marcus
Biondi‐Zoccai, Giuseppe
Fremes, Stephen E.
Disagreement Between Randomized and Observational Evidence on the Use of Bilateral Internal Thoracic Artery Grafting: A Meta‐Analytic Approach
title Disagreement Between Randomized and Observational Evidence on the Use of Bilateral Internal Thoracic Artery Grafting: A Meta‐Analytic Approach
title_full Disagreement Between Randomized and Observational Evidence on the Use of Bilateral Internal Thoracic Artery Grafting: A Meta‐Analytic Approach
title_fullStr Disagreement Between Randomized and Observational Evidence on the Use of Bilateral Internal Thoracic Artery Grafting: A Meta‐Analytic Approach
title_full_unstemmed Disagreement Between Randomized and Observational Evidence on the Use of Bilateral Internal Thoracic Artery Grafting: A Meta‐Analytic Approach
title_short Disagreement Between Randomized and Observational Evidence on the Use of Bilateral Internal Thoracic Artery Grafting: A Meta‐Analytic Approach
title_sort disagreement between randomized and observational evidence on the use of bilateral internal thoracic artery grafting: a meta‐analytic approach
topic Brief Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912987/
https://www.ncbi.nlm.nih.gov/pubmed/31752642
http://dx.doi.org/10.1161/JAHA.119.014638
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