Unmeasured Confounders in Observational Studies Comparing Bilateral Versus Single Internal Thoracic Artery for Coronary Artery Bypass Grafting: A Meta-Analysis

Journal of the American Heart Association
Mario GaudinoStephen E Fremes

Abstract

Observational studies suggest a survival advantage with bilateral single internal thoracic artery (BITA) versus single internal thoracic artery grafting for coronary surgery, whereas this conclusion is not supported by randomized trials. We hypothesized that this inconsistency is attributed to unmeasured confounders intrinsic to observational studies. To test our hypothesis, we performed a meta-analysis of the observational literature comparing BITA and single internal thoracic artery, deriving incident rate ratio for mortality at end of follow-up and at 1 year. We postulated that BITA would not affect 1-year survival based on the natural history of coronary artery bypass occlusion, so that a difference between groups at 1 year could not be attributed to the intervention. We searched MEDLINE and Pubmed to identify all observational studies comparing the outcome of BITA versus single internal thoracic artery. One-year and long-term mortality for BITA and single internal thoracic artery were compared in the propensity-score-matched (PSM) series, that is, the form of observational evidence less prone to confounders. Thirty-eight observational studies (174 205 total patients) were selected for final comparison. In the 12 propensity...Continue Reading

References

Jan 2, 1986·The New England Journal of Medicine·F D LoopW C Sheldon
Sep 1, 1986·Controlled Clinical Trials·R DerSimonian, N Laird
Oct 6, 1997·The Annals of Thoracic Surgery·A W PickH V Schaff
Apr 30, 1999·The Journal of Thoracic and Cardiovascular Surgery·B W LytleD M Cosgrove
Nov 28, 2001·The Annals of Thoracic Surgery·E BerreklouwP Westers
Nov 5, 2002·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Giulio RizzoliPierantonio Bellini
Sep 6, 2003·BMJ : British Medical Journal·Julian P T HigginsDouglas G Altman
Dec 12, 2003·The Annals of Thoracic Surgery·Takashi HirotaniShigeyuki Takeuchi
Jan 17, 2004·The Annals of Thoracic Surgery·James TatoulisJohn A Fuller
Aug 11, 2004·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Antonio Maria CalafioreGiuseppe Vitolla
Nov 25, 2004·The Annals of Thoracic Surgery·Bruce W LytleDelos M Cosgrove
Sep 15, 2005·Circulation·Mario GaudinoGianfederico Possati
Jan 24, 2006·The Annals of Thoracic Surgery·Ioannis K ToumpoulisJoseph J DeRose
Apr 22, 2009·The Journal of Thoracic and Cardiovascular Surgery·Giuseppe NassoGiuseppe Speziale
Jul 22, 2009·PLoS Medicine·David MoherUNKNOWN PRISMA Group
Oct 1, 2011·The Annals of Thoracic Surgery·Teresa M KieserUNKNOWN APPROACH Investigators
Jun 14, 2012·Journal of Cardiac Surgery·Giuseppe NassoGiuseppe Speziale
Feb 14, 2013·The Journal of Thoracic and Cardiovascular Surgery·Cyrus J ParsaPeter K Smith
Feb 21, 2014·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Siamak MohammadiPierre Voisine
Apr 2, 2014·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Umberto BenedettoGiacomo Frati
May 21, 2014·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Matteo PettinariBart Meuris
Sep 27, 2014·The Journal of Thoracic and Cardiovascular Surgery·Umberto BenedettoUNKNOWN Harefield Cardiac Outcomes Research Group
Feb 5, 2015·The Journal of Thoracic and Cardiovascular Surgery·Juan B GrauAlex Zapolanski
Mar 13, 2015·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Thomas A SchwannRobert H Habib
Jul 5, 2015·The Journal of Thoracic and Cardiovascular Surgery·Takeshi KinoshitaTomoaki Suzuki
Jul 21, 2015·The Journal of Thoracic and Cardiovascular Surgery·Benjamin MedalionDmitry Pevni

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Citations

Jan 8, 2018·Journal of the American Heart Association·Christopher T RyanTodd K Rosengart
Oct 31, 2018·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Miguel Sousa-UvaMarc Ruel
Oct 31, 2018·Journal of the American Heart Association·Mario GaudinoDavid P Taggart
Aug 31, 2018·European Heart Journal·Franz-Josef NeumannUNKNOWN ESC Scientific Document Group
Mar 8, 2019·Journal of Diabetes Science and Technology·David C Klonoff
Oct 24, 2018·Cardiovascular Research·Mario Gaudino, David P Taggart
Sep 20, 2019·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Mario GaudinoUNKNOWN RADIAL Investigators
Mar 20, 2020·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Mario GaudinoDavid P Taggart
Jun 21, 2019·Current Opinion in Cardiology·Cristiano SpadaccioMario F L Gaudino
Sep 15, 2020·Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia·Nicolai BayerMichael Schmoeckel
Aug 15, 2018·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Mario GaudinoPhilippe Kolh
Jan 23, 2019·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Franz-Josef NeumannMichael O Zembala
Nov 27, 2018·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Mario GaudinoPhilippe Kolh
Aug 21, 2020·Journal of the American Heart Association·Mario GaudinoStephen Fremes
Jul 22, 2018·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Mario Gaudino, David P Taggart
May 1, 2018·The New England Journal of Medicine·Mario GaudinoUNKNOWN RADIAL Investigators
Aug 31, 2018·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Miguel Sousa-UvaUNKNOWN ESC Scientific Document Group
Jan 17, 2019·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Michele Di MauroMario Gaudino
Jan 15, 2020·Circulation·Mario GaudinoUNKNOWN ATLANTIC (Arterial Grafting International Consortium) Alliance members
Sep 10, 2019·European Heart Journal·Francesco CosentinoUNKNOWN ESC Scientific Document Group
Oct 6, 2020·Circulation·Brian F BuxtonUNKNOWN RAPCO Investigators*
Dec 1, 2018·Indian Journal of Thoracic and Cardiovascular Surgery : Official Organ, Association of Thoracic and Cardiovascular Surgeons of India·Jeremy R LeonardMario F L Gaudino
Oct 22, 2020·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Mario GaudinoStephen E Fremes
Nov 29, 2020·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Mario F L GaudinoUNKNOWN Coronary Task Force of the European Association for Cardio-Thoracic Surgery
Sep 6, 2018·The Journal of Thoracic and Cardiovascular Surgery·Rodolfo V RochaStephen E Fremes
Mar 10, 2021·Journal of the American Heart Association·Mario GaudinoStephen E Fremes
Mar 24, 2021·Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery·Katia AudisioMario Gaudino
Jan 25, 2020·The Journal of Thoracic and Cardiovascular Surgery·Rodolfo V RochaStephen E Fremes
Dec 15, 2020·The Journal of Thoracic and Cardiovascular Surgery·Chaim Locker
Dec 16, 2018·The Journal of Thoracic and Cardiovascular Surgery·Mario GaudinoStephen E Fremes
May 8, 2021·The Journal of Thoracic and Cardiovascular Surgery·N Bryce Robinson, Mario Gaudino
Aug 28, 2020·Seminars in Thoracic and Cardiovascular Surgery·Ruth M Masterson CreberMario Gaudino
Jun 22, 2021·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Donna Rahmatian, Mina Tadrous
Aug 5, 2021·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Saqib H QureshiSurendra Naik
Dec 15, 2020·The Journal of Thoracic and Cardiovascular Surgery·Mario GaudinoStephen Fremes
Sep 4, 2021·Current Opinion in Cardiology·N Bryce RobinsonMario Gaudino
Oct 14, 2021·European Heart Journal. Quality of Care & Clinical Outcomes·Ruth Masterson CreberMario Gaudino

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Methods Mentioned

BETA
coronary artery bypass

Software Mentioned

GetData Graph Digitizer
CMA
BITA

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