Early mortality and morbidity of bilateral versus single internal thoracicartery revascularization: Propensity and risk modeling

OBJECTIVES We examined whether bilateral internal thoracic artery (BITA) re vascularization is associated with any increased in-hospital mortality and complications compared with single internal thoracic artery (SITA) revascul arization. BACKGROUND Despite proven long-term benefits, BITA revascularization has be en slow to be adopted because of fear of increased early morbidity. METHODS We evaluated 1,697 consecutive patients undergoing BITA (n = 867) o r SITA (n = 830) revascularization. We used propensity score analyses and a djusted risk models to address differences between arms. RESULTS There were 20 (2.3%) deaths in the BITA group versus 26 (3.1%) in t he SITA group (odds ratio 0.73, p = 0.30). Propensity analysis identified s everal parameters that affected the decision to use BITA. Adjusting for pro pensity score and all potential risk factors, the odds ratio for death with BITA versus SITA was practically 1. Bilateral internal thoracic artery rev ascularization did not increase the number of in-hospital complications wit h the possible exception of deep sternal wound infections (11 [1.3%] vs. 3 [0.4%], p = 0.057). In multivariate modeling BITA increased the risk of dee p sternal wound infections only in emergent cases and in older patients; th e excess risk was negligible among 1,206 patients (71.1% of total) who did not have emergent revascularization and were less than or equal to 70 years old (risk difference 0.3%, p = 0.74). There was no difference in length of stay after adjustment for propensity factors (mean 11.3 vs. 11.7 days, p = 0.66). CONCLUSIONS Bilateral internal thoracic artery revascularization grafting c onfers no increased risk for early death and does not prolong hospital stay . The small increase in the risk of deep sternal wound infections does not affect the majority of patients. (J Am Coil Cardiol 2001;37:521-8) (C) 2001 by the American College of Cardiology.