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Coronary Artery Disease: HELP
Articles by Mario Gaudino
Based on 24 articles published since 2008
(Why 24 articles?)
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Between 2008 and 2019, Mario Gaudino wrote the following 24 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Editorial On diet, exercise … and arterial grafting. 2015

Gaudino, Mario. ·Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, USA; Department of Cardiovascular Sciences, Catholic University, Rome, Italy. Electronic address: mfg9004@med.cornell.edu. ·Int J Cardiol · Pubmed #25897914.

ABSTRACT: -- No abstract --

2 Editorial Sirens versus facts: mastering good old techniques in an era of innovation enthusiasm. 2012

Gaudino, Mario. · ·Cardiology · Pubmed #22441337.

ABSTRACT: -- No abstract --

3 Review Percutaneous coronary intervention or coronary artery bypass graft in left main coronary artery disease: a comprehensive meta-analysis of adjusted observational studies and randomized controlled trials. 2018

Bertaina, Maurizio / De Filippo, Ovidio / Iannaccone, Mario / Colombo, Antonio / Stone, Gregg / Serruys, Patrick / Mancone, Massimo / Omedè, Pierluigi / Conrotto, Federico / Pennone, Mauro / Kimura, Takeshi / Kawamoto, Hiroyoshi / Zoccai, Giuseppe Biondi / Sheiban, Imad / Templin, Christian / Benedetto, Umberto / Cavalcante, Rafael / D'Amico, Maurizio / Gaudino, Mario / Moretti, Claudio / Gaita, Fiorenzo / D'Ascenzo, Fabrizio. ·Division of Cardiology, Città Della Salute e della Scienza, Molinette Hospital, Turin. · Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy. · Cardiovascular Research and Education Columbia University Medical Center, Presbyterian Hospital, New York, USA. · Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands. · Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, University 'La Sapienza' of Rome, Rome, Italy. · Department of Cardiovascular Medicine, Kyoto University, Japan. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina. · Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli. · Cardiology Department, Pederzoli Hospital, Verona, Italy. · University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland. · Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom. · Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA. ·J Cardiovasc Med (Hagerstown) · Pubmed #30095584.

ABSTRACT: BACKGROUND: Treatment of patients with ULMCA (unprotected left main coronary artery disease) with percutaneous coronary intervention (PCI) has been compared with coronary artery bypass graft (CABG), without conclusive results. METHODS: All randomized controlled trials (RCTs) and observational studies with multivariate analysis comparing PCI and CABG for ULMCA were included. Major cardiovascular events (MACEs, composite of all-cause death, MI, definite or probable ST, target vessel revascularization and stroke) were the primary end points, whereas its single components were the secondary ones, along with stent thrombosis, graft occlusion and in-hospital death and stroke. Subgroup analyses were performed according to Syntax score. RESULTS: Six RCTs (4717 patients) and 20 observational studies with multivariate adjustment (14 597 patients) were included. After 5 (3-5.5) years, MACE rate was higher for PCI [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.07-1.14], without difference in death, whereas more relevant risk of MI was because of observational studies. Coronary stenting increased risk of revascularization (OR 1.52; 95% CI 1.34-1.72). At meta-regression, performance of PCI was improved by use of intra-coronary imaging and worsened by first generation stents, whereas two arterial grafts increased benefit of CABG. For patients with Syntax score less than 22, MACE rates did not differ, whereas for higher values, CABG reduced MACE because of lower risk of revascularization. Incidence of graft occlusion was 3.24% (2.25-4.23), whereas 2.13% (1.28-2.98: all CI 95%) of patients experienced stent thrombosis. CONCLUSION: Surgical revascularization reduces risk of revascularization for ULMCA patients, especially for those with Syntax score greater than 22, with a higher risk of in-hospital death. Intra-coronary imaging and use of arterial grafts improved performance of revascularization strategies.

4 Review Implications of coronary artery bypass grafting and percutaneous coronary intervention on disease progression and the resulting changes to the physiology and pathology of the native coronary arteries. 2018

Fortier, Jacqueline H / Ferrari, Giovanni / Glineur, David / Gaudino, Mario / Shaw, Richard E / Ruel, Marc / Grau, Juan B. ·Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada. · Department of Surgery, Columbia University, New York, USA. · Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York, USA. · The Valley Columbia Heart Center, Ridgewood, New Jersey, USA. ·Eur J Cardiothorac Surg · Pubmed #29688287.

ABSTRACT: Myocardial revascularization can be achieved through 2 different methods: coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). Clinical trials comparing PCI and CABG generally use the composite end points of death, stroke, myocardial infarction and target vessel revascularization to determine superiority. Other effects of these interventions, including the preservation of normal coronary physiology, the response of the coronary tree to stressors and the response of the vessel wall to the revascularization intervention, are not routinely considered, but these may have significant implications for patients in the medium and long term. For PCI, relatively small differences in clinical outcomes have been reported between bare metal and drug-eluting stents, and the latter seems to have inconsistent and somewhat unpredictable effects on the vascular biology of the coronary arteries. In coronary bypass, the use of arterial conduits is associated with superior clinical outcomes, better long-term patency and the preservation of essentially normal coronary function after intervention. This review assembles the clinical, physiological, angiographic and pathological literature currently available and attempts to provide a more complete picture of the effects of CABG and PCI on coronary arteries.

5 Review Mechanisms, Consequences, and Prevention of Coronary Graft Failure. 2017

Gaudino, Mario / Antoniades, Charalambos / Benedetto, Umberto / Deb, Saswata / Di Franco, Antonino / Di Giammarco, Gabriele / Fremes, Stephen / Glineur, David / Grau, Juan / He, Guo-Wei / Marinelli, Daniele / Ohmes, Lucas B / Patrono, Carlo / Puskas, John / Tranbaugh, Robert / Girardi, Leonard N / Taggart, David P / Anonymous2570925. ·From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.) · Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.) · Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.) · Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.) · University "G. D'Annunzio," Chieti, Italy (G.D.G., D.M.) · Division of Cardiac Surgery, Ottawa Heart Institute, Canada (D.G., J.G.) · TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (G.-W.H.) · Department of Pharmacology, Catholic University School of Medicine, Rome, Italy (C.P.) · and Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai,New York (J.P.). ·Circulation · Pubmed #29084780.

ABSTRACT: Graft failure occurs in a sizeable proportion of coronary artery bypass conduits. We herein review relevant current evidence to give an overview of the incidence, pathophysiology, and clinical consequences of this multifactorial phenomenon. Thrombosis, endothelial dysfunction, vasospasm, and oxidative stress are different mechanisms associated with graft failure. Intrinsic morphological and functional features of the bypass conduits play a role in determining failure. Similarly, characteristics of the target coronary vessel, such as the severity of stenosis, the diameter, the extent of atherosclerotic burden, and previous endovascular interventions, are important determinants of graft outcome and must be taken into consideration at the time of surgery. Technical factors, such as the method used to harvest the conduits, the vasodilatory protocol, the storage solution, and the anastomotic technique, also play a major role in determining graft success. Furthermore, systemic atherosclerotic risk factors, such as age, sex, diabetes mellitus, hypertension, and dyslipidemia, have been variably associated with graft failure. The failure of a coronary graft is not always correlated with adverse clinical events, which vary according to the type, location, and reason for failed graft. Intraoperative flow verification and secondary prevention using antiplatelet and lipid-lowering agents can help reducing the incidence of graft failure.

6 Review Randomized comparison of the clinical outcome of single versus multiple arterial grafts: the ROMA trial-rationale and study protocol. 2017

Gaudino, Mario / Alexander, John H / Bakaeen, Faisal G / Ballman, Karla / Barili, Fabio / Calafiore, Antonio Maria / Davierwala, Piroze / Goldman, Steven / Kappetein, Peter / Lorusso, Roberto / Mylotte, Darren / Pagano, Domenico / Ruel, Marc / Schwann, Thomas / Suma, Hisayoshi / Taggart, David P / Tranbaugh, Robert F / Fremes, Stephen. ·Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA. · Duke Clinical Research Institute, Duke Health, Durham, NC, USA. · Cleveland Clinic Foundation, Cleveland, OH, USA. · Department of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA. · Department of Cardiovascular Surgery, S. Croce e Carle Hospital, Cuneo, Italy. · Fondazione Giovanni Paolo II, Campobasso, Italy. · Herzzentrum Leipzig, Leipzig, Germany. · Department of Medicine, University of Arizona, Tucson, AZ, USA. · Thoraxcenter, Erasmus MC, Rotterdam, Netherlands. · Maastricht University Medical Centre, Maastricht, Netherlands. · Galway University Hospitals, Galway, Ireland. · University Hospital Birmingham, Birmingham, UK. · University of Ottawa Heart Institute, Ottawa, ON, Canada. · The University of Toledo, Toledo, OH, USA. · Suma Heart Clinic, Tokyo, Japan. · University of Oxford, Oxford, UK. · Sunnybrook Health Science, University of Toronto, Toronto, ON, Canada. ·Eur J Cardiothorac Surg · Pubmed #29059371.

ABSTRACT: SUMMARY: The primary hypothesis of the ROMA trial is that in patients undergoing primary isolated non-emergent coronary artery bypass grafting, the use of 2 or more arterial grafts compared with a single arterial graft (SAG) is associated with a reduction in the composite outcome of death from any cause, any stroke, post-discharge myocardial infarction and/or repeat revascularization. The secondary hypothesis is that in these patients, the use of 2 or more arterial grafts compared with a SAG is associated with improved survival. The ROMA trial is a prospective, unblinded, randomized event-driven multicentre trial comprising at least 4300 subjects. Patients younger than 70 years with left main and/or multivessel disease will be randomized to a SAG or multiple arterial grafts to the left coronary system in a 1:1 fashion. Permuted block randomization stratified by the centre and the type of second arterial graft will be used. The primary outcome will be a composite of death from any cause, any stroke, post-discharge myocardial infarction and/or repeat revascularization. The secondary outcome will be all-cause mortality. The primary safety outcome will be a composite of death from any cause, any stroke and any myocardial infarction. In all patients, 1 internal thoracic artery will be anastomosed to the left anterior descending coronary artery. For patients randomized to the SAG group, saphenous vein grafts will be used for all non-left anterior descending target vessels. For patients randomized to the multiple arterial graft group, the main target vessel of the lateral wall will be grafted with either a radial artery or a second internal thoracic artery. Additional grafts for the multiple arterial graft group can be saphenous veins or supplemental arterial conduits. To detect a 20% relative reduction in the primary outcome, with 90% power at 5% alpha and assuming a time-to-event analysis, the sample size must include 845 events (and 3650 patients). To detect a 20% relative reduction in the secondary outcome, with 80% power at 5% alpha, the sample size must include 631 events (and 3650 patients). To be conservative, the sample size will be set at 4300 patients. The primary outcome will be tested according to the intention-to-treat principle. The primary analysis will be a Cox proportional hazards regression model, with the treatment arm included as a covariate. If non-proportional hazards are observed, alternatives to Cox proportional hazards regression will be explored.

7 Review Three Arterial Grafts Improve Late Survival: A Meta-Analysis of Propensity-Matched Studies. 2017

Gaudino, Mario / Puskas, John D / Di Franco, Antonino / Ohmes, Lucas B / Iannaccone, Mario / Barbero, Umberto / Glineur, David / Grau, Juan B / Benedetto, Umberto / D'Ascenzo, Fabrizio / Gaita, Fiorenzo / Girardi, Leonard N / Taggart, David P. ·From Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., A.D.F., L.B.O., L.N.G.) · Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.D.P.) · Città della Scienza e della Salute, Department of Cardiology, University of Turin, Italy (M.I., U.B., F.D., F.G.) · Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (D.G., J.B.G.) · Bristol Heart Institute, University of Bristol, UK (U.B.) · and Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, UK (D.P.T.). ·Circulation · Pubmed #28119382.

ABSTRACT: BACKGROUND: Little evidence shows whether a third arterial graft provides superior outcomes compared with the use of 2 arterial grafts in patients undergoing coronary artery bypass grafting. A meta-analysis of all the propensity score-matched observational studies comparing the long-term outcomes of coronary artery bypass grafting with the use of 2-arterial versus 3-arterial grafts was performed. METHODS: A literature search was conducted using MEDLINE, EMBASE, and Web of Science to identify relevant articles. Long-term mortality in the propensity score-matched populations was the primary end point. Secondary end points were in-hospital/30-day mortality for the propensity score-matched populations and long-term mortality for the unmatched populations. In the matched population, time-to-event outcome for long-term mortality was extracted as hazard ratios, along with their variance. Statistical pooling of survival (time-to-event) was performed according to a random effect model, computing risk estimates with 95% confidence intervals. RESULTS: Eight propensity score-matched studies reporting on 10 287 matched patients (2-arterial graft: 5346; 3-arterial graft: 4941) were selected for final comparison. The mean follow-up time ranged from 37.2 to 196.8 months. The use of 3 arterial grafts was not statistically associated with early mortality (hazard ratio, 0.93; 95% confidence interval, 0.71-1.22; CONCLUSIONS: The use of a third arterial conduit in patients with coronary artery bypass grafting is not associated with higher operative risk and is associated with superior long-term survival, irrespective of sex and diabetic mellitus status.

8 Review The Evolution of Coronary Bypass Surgery Will Determine Its Relevance as the Standard of Care for the Treatment for Multivessel Coronary Artery Disease. 2016

Glineur, David / Gaudino, Mario / Grau, Juan. ·From the Division of Cardiac Surgery, Ottawa Heart Institute, University of Ottawa, Canada (D.G.) · Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York (M.G.) · Department of Cardiac Surgery, Valley Heart and Vascular Institute, Ridgewood, NJ (J.G.) · and Division of Cardiothoracic Surgery, The University of Pennsylvania School of Medicine, Philadelphia (J.G.). ·Circulation · Pubmed #27777289.

ABSTRACT: -- No abstract --

9 Review Coronary surgery is superior to drug eluting stents in multivessel disease. Systematic review and meta-analysis of contemporary randomized controlled trials. 2016

Benedetto, Umberto / Gaudino, Mario / Ng, Colin / Biondi-Zoccai, Giuseppe / D'Ascenzo, Fabrizio / Frati, Giacomo / Girardi, Leonard N / Angelini, Gianni D / Taggart, David P. ·Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, UK. Electronic address: umberto.benedetto@hotmail.com. · Division of Cardio-thoracic Surgery, Cornell University, New York, NY, USA. · Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, UK. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Eleonora Lorillard Spencer Cenci Foundation, Rome, Italy. · Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli, Italy. · Nuffield Department of Surgical Sciences, Oxford University Hospital, Oxford, UK. ·Int J Cardiol · Pubmed #26922707.

ABSTRACT: OBJECTIVE: Current randomized controlled trials (RCTs) comparing percutaneous coronary intervention with drug eluting stent (DES-PCI) with coronary artery bypass grafting (CABG) in multivessel disease are underpowered to detect a difference in hard clinical end-points such as mortality, myocardial infarction and stroke. We aimed to overcome this limitation by conducting a meta-analysis of contemporary RCTs. METHODS: A systematic literature search was conducted for all RCTs comparing DES-PCI versus CABG in multivessel disease published through May 2015. Inverse variance weighting was used to pool data from individual studies (<1 favouring DES-PCI and >1 CABG favouring surgery). RESULTS: A total of five randomized trials including 4563 subjects were analysed. After an average follow-up of 3.4 years, DES-PCI was associated with a significantly increased risk of overall mortality (HR 1.51; 95%CI 1.23-1.84; P<0.001), MI (HR 2.02; 95%CI 1.57-2.58; P<0.001) and repeat revascularization (HR 2.54; 95%CI 2.07-3.11; P=<0.001). CABG marginally increased the risk of stroke (HR 0.70; 95%CI 0.50-0.98; P=0.04). The absolute risk reduction for all-cause mortality (3.3%) and myocardial infarction (4.3%) with CABG was larger than the absolute risk reduction for stroke (0.9%) with DES-PCI. CONCLUSION: In patients with multivessel coronary disease, CABG was found to be superior to DES-PCI by reducing the risk of mortality and subsequent myocardial infarction at the expense of a marginally increased risk of stroke.

10 Review The Choice of Conduits in Coronary Artery Bypass Surgery. 2015

Gaudino, Mario / Taggart, David / Suma, Hisayoshi / Puskas, John D / Crea, Filippo / Massetti, Massimo. ·Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York; Department of Cardiovascular Sciences, Catholic University, Rome, Italy. Electronic address: mfg9004@med.cornell.edu. · University of Oxford, Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom. · Suma Heart Clinic, Tokyo, Japan. · Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York. · Department of Cardiovascular Sciences, Catholic University, Rome, Italy. ·J Am Coll Cardiol · Pubmed #26449144.

ABSTRACT: Coronary artery bypass grafting is the most common cardiac surgery operation performed worldwide. It is the most effective revascularization method for several categories of patients affected by coronary artery disease. Although coronary artery bypass grafting has been performed for more than 40 years, no detailed guidelines on the choice of coronary artery bypass grafting conduits have been published and the choice of the revascularization strategy remains more a matter of art than of science. Moreover, there is a clear contradiction between the proven benefits of arterial grafting and its very limited use in everyday clinical practice. In the hope of encouraging wider diffusion of arterial revascularization and to provide a guide for clinicians, we discuss current evidence for the use of different conduits in coronary artery bypass surgery and propose an evidence-based algorithm for the choice of the second conduit during coronary artery bypass operations.

11 Review Technical issues in the use of the radial artery as a coronary artery bypass conduit. 2014

Gaudino, Mario / Crea, Filippo / Cammertoni, Federico / Mazza, Andrea / Toesca, Amelia / Massetti, Massimo. ·Department of Cardiovascular Medicine, Catholic University, Rome, Italy. Electronic address: mgaudino@tiscali.it. · Department of Cardiovascular Medicine, Catholic University, Rome, Italy. · Department of Anatomy, Catholic University, Rome, Italy. ·Ann Thorac Surg · Pubmed #25443025.

ABSTRACT: The clinical and angiographic benefits related to the use of the radial artery (RA) as a bypass conduit have extensively been proven. However, due to its morpho-functional features and its anatomic position, successful use of the RA requires careful consideration of several technical issues. We herein summarize the current evidence on all the technical aspects related to the RA use in coronary surgery such as the preoperative evaluation of ulnar compensation, the different means of intraoperative vasodilatation, and the various harvesting techniques.

12 Review Morpho-functional features of the radial artery: implications for use as a coronary bypass conduit. 2014

Gaudino, Mario / Crea, Filippo / Cammertoni, Federico / Mazza, Andrea / Toesca, Amelia / Massetti, Massimo. ·Department of Cardiovascular Medicine, Catholic University, Rome, Italy. Electronic address: mgaudino@tiscali.it. · Department of Cardiovascular Medicine, Catholic University, Rome, Italy. · Department of Anatomy, Catholic University, Rome, Italy. ·Ann Thorac Surg · Pubmed #25258159.

ABSTRACT: Since its reintroduction in the early 1990s the radial artery has gained a major role in coronary surgery, currently representing a valid alternative to the right internal thoracic artery as a second arterial graft. However, its peculiar morphologic and functional features have both surgical and clinical critical implications that must be taken into account. In this review we summarize the current totality of evidence on the biologic characteristics of the radial artery, such as its histopathology, vasoreactivity, and remodeling, and discuss their potential implications for use as a coronary bypass conduit.

13 Review The use of internal thoracic artery grafts in patients with aortic coarctation. 2013

Gaudino, Mario / Farina, Piero / Toesca, Amelia / Bonalumi, Giorgia / Tsiopoulos, Vasileios / Bruno, Piergiorgio / Massetti, Massimo. ·Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University, Rome, Italy. ·Eur J Cardiothorac Surg · Pubmed #23435522.

ABSTRACT: The choice of conduits for surgical revascularization in patients with aortic coarctation can be puzzling, as the internal thoracic arteries can be dilated, atherosclerotic and unsuitable for grafting. Reports in the literature are controversial: in some cases, the internal thoracic artery was not suitable for revascularization, while in others, it could be used with discordant outcomes. Here, we review the literature on the subject.

14 Article Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years. 2019

Taggart, David P / Benedetto, Umberto / Gerry, Stephen / Altman, Douglas G / Gray, Alastair M / Lees, Belinda / Gaudino, Mario / Zamvar, Vipin / Bochenek, Andrzej / Buxton, Brian / Choong, Cliff / Clark, Stephen / Deja, Marek / Desai, Jatin / Hasan, Ragheb / Jasinski, Marek / O'Keefe, Peter / Moraes, Fernando / Pepper, John / Seevanayagam, Siven / Sudarshan, Catherine / Trivedi, Uday / Wos, Stanislaw / Puskas, John / Flather, Marcus / Anonymous4131080. ·From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom · the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York · the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland · the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.) · and the Heart Institute of Pernambuco, Recife, Brazil (F.M.). ·N Engl J Med · Pubmed #30699314.

ABSTRACT: BACKGROUND: Multiple arterial grafts may result in longer survival than single arterial grafts after coronary-artery bypass grafting (CABG) surgery. We evaluated the use of bilateral internal-thoracic-artery grafts for CABG. METHODS: We randomly assigned patients scheduled for CABG to undergo bilateral or single internal-thoracic-artery grafting. Additional arterial or vein grafts were used as indicated. The primary outcome was death from any cause at 10 years. The composite of death from any cause, myocardial infarction, or stroke was a secondary outcome. RESULTS: A total of 1548 patients were randomly assigned to undergo bilateral internal-thoracic-artery grafting (the bilateral-graft group) and 1554 to undergo single internal-thoracic-artery grafting (the single-graft group). In the bilateral-graft group, 13.9% of the patients received only a single internal-thoracic-artery graft, and in the single-graft group, 21.8% of the patients also received a radial-artery graft. Vital status was not known for 2.3% of the patients at 10 years. In the intention-to-treat analysis at 10 years, there were 315 deaths (20.3% of the patients) in the bilateral-graft group and 329 deaths (21.2%) in the single-graft group (hazard ratio, 0.96; 95% confidence interval [CI], 0.82 to 1.12; P=0.62). Regarding the composite outcome of death, myocardial infarction, or stroke, there were 385 patients (24.9%) with an event in the bilateral-graft group and 425 patients (27.3%) with an event in the single-graft group (hazard ratio, 0.90; 95% CI, 0.79 to 1.03). CONCLUSIONS: Among patients who were scheduled for CABG and had been randomly assigned to undergo bilateral or single internal-thoracic-artery grafting, there was no significant between-group difference in the rate of death from any cause at 10 years in the intention-to-treat analysis. Further studies are needed to determine whether multiple arterial grafts provide better outcomes than a single internal-thoracic-artery graft. (Funded by the British Heath Foundation and others; Current Controlled Trials number, ISRCTN46552265 .).

15 Article Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery. 2018

Gaudino, Mario / Benedetto, Umberto / Fremes, Stephen / Biondi-Zoccai, Giuseppe / Sedrakyan, Art / Puskas, John D / Angelini, Gianni D / Buxton, Brian / Frati, Giacomo / Hare, David L / Hayward, Philip / Nasso, Giuseppe / Moat, Neil / Peric, Miodrag / Yoo, Kyung J / Speziale, Giuseppe / Girardi, Leonard N / Taggart, David P / Anonymous4170945. ·From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York · Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom · Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.) · the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy · the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia · Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.) · and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.). ·N Engl J Med · Pubmed #29708851.

ABSTRACT: BACKGROUND: The use of radial-artery grafts for coronary-artery bypass grafting (CABG) may result in better postoperative outcomes than the use of saphenous-vein grafts. However, randomized, controlled trials comparing radial-artery grafts and saphenous-vein grafts have been individually underpowered to detect differences in clinical outcomes. We performed a patient-level combined analysis of randomized, controlled trials to compare radial-artery grafts and saphenous-vein grafts for CABG. METHODS: Six trials were identified. The primary outcome was a composite of death, myocardial infarction, or repeat revascularization. The secondary outcome was graft patency on follow-up angiography. Mixed-effects Cox regression models were used to estimate the treatment effect on the outcomes. RESULTS: A total of 1036 patients were included in the analysis (534 patients with radial-artery grafts and 502 patients with saphenous-vein grafts). After a mean (±SD) follow-up time of 60±30 months, the incidence of adverse cardiac events was significantly lower in association with radial-artery grafts than with saphenous-vein grafts (hazard ratio, 0.67; 95% confidence interval [CI], 0.49 to 0.90; P=0.01). At follow-up angiography (mean follow-up, 50±30 months), the use of radial-artery grafts was also associated with a significantly lower risk of occlusion (hazard ratio, 0.44; 95% CI, 0.28 to 0.70; P<0.001). As compared with the use of saphenous-vein grafts, the use of radial-artery grafts was associated with a nominally lower incidence of myocardial infarction (hazard ratio, 0.72; 95% CI, 0.53 to 0.99; P=0.04) and a lower incidence of repeat revascularization (hazard ratio, 0.50; 95% CI, 0.40 to 0.63; P<0.001) but not a lower incidence of death from any cause (hazard ratio, 0.90; 95% CI, 0.59 to 1.41; P=0.68). CONCLUSIONS: As compared with the use of saphenous-vein grafts, the use of radial-artery grafts for CABG resulted in a lower rate of adverse cardiac events and a higher rate of patency at 5 years of follow-up. (Funded by Weill Cornell Medicine and others.).

16 Article Systematic bilateral internal mammary artery grafting: lessons learned from the CATHolic University EXtensive BIMA Grafting Study. 2018

Gaudino, Mario / Glieca, Franco / Luciani, Nicola / Pragliola, Claudio / Tsiopoulos, Vasileios / Bruno, Piergiorgio / Farina, Piero / Bonalumi, Giorgia / Pavone, Natalia / Nesta, Marialisa / Cammertoni, Federico / Munjal, Monica / Di Franco, Antonino / Massetti, Massimo. ·Department of Cardiovascular Sciences, Catholic University, Rome, Italy. · Department of Cardiothoracic Surgery, Cornell Medicine, New York, NY, USA. ·Eur J Cardiothorac Surg · Pubmed #29672700.

ABSTRACT: OBJECTIVES: Despite claims of feasibility, to date no study has examined the effect of systematic bilateral internal mammary artery (BIMA) use in a large cohort of real-world unselected patients. The CATHolic University EXtensive BIMA Grafting Study (CATHEXIS) registry was designed to assess the feasibility and safety of systematic BIMA grafting. METHODS: The CATHEXIS was a single-centre, prospective, observational, propensity-matched study. The study was supposed to include 2 arms of 500 patients each: a prospective arm and a retrospective arm. The prospective arm included almost all patients referred for coronary artery bypass grafting (CABG) at our institution after the start of the CATHEXIS with very few exceptions. BIMA would have been used in all these patients. The retrospective arm included patients submitted to CABG before the start of the CATHEXIS and propensity matched to the prospective group (average BIMA use 50%; the radial artery was extensively used). Safety analyses were scheduled after enrolment of 200, 300 and 400 BIMA patients. RESULTS: After the first 226 patients, the BIMA use percentage was 88.5% (200 of 226). In 178 (89%) patients, mammary arteries were used as Y graft. Postoperative mortality was 2%, and incidence of perioperative myocardial infarction, graft failure and sternal complications were 3.5%, 3% and 5.5%, respectively. No perioperative stroke occurred. The incidence of major adverse cardiac events (particularly graft failure and sternal complications) in the BIMA arm were significantly higher than those in the propensity-matched cohort; the study was stopped for safety. CONCLUSIONS: In a real world setting the systematic use of BIMA was associated with a higher incidence of perioperative adverse events (particularly sternal complications). Individualization of the revascularization strategy and use of alternative arterial conduits are probably preferable to systematic use of BIMA.

17 Article Continuing Conundrum of Multiple Arterial Conduits for Coronary Artery Bypass Grafting. 2018

Gaudino, Mario / Fremes, Stephen E / Taggart, David P. ·Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY (M.G.). mfg9004@med.cornell.edu. · Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Ontario, Canada (S.E.F.). · University of Oxford, United Kingdom (D.P.T.). ·Circulation · Pubmed #29661948.

ABSTRACT: -- No abstract --

18 Article Totally endoscopic coronary artery bypass surgery: A meta-analysis of the current evidence. 2018

Leonard, Jeremy R / Rahouma, Mohamed / Abouarab, Ahmed A / Schwann, Alexandra N / Scuderi, Gaetano / Lau, Christopher / Guy, T Sloane / Demetres, Michelle / Puskas, John D / Taggart, David P / Girardi, Leonard N / Gaudino, Mario. ·Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States. · Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY, United States. · Icahn School of Medicine at Mount Sinai, New York, NY, United States. · Department of Cardiovascular Surgery, University of Oxford, United Kingdom. · Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States. Electronic address: mfg9004@med.cornell.edu. ·Int J Cardiol · Pubmed #29657055.

ABSTRACT: BACKGROUND: Totally endoscopic coronary artery bypass (TECAB) has emerged as an alternative to other minimally invasive techniques. However, limited TECAB results are available to date. The purpose of this systematic review is to examine the existing literature to give an objective estimate of the outcomes of TECAB using a meta-analytical approach. METHODS: A comprehensive online review was performed in Ovid MEDLINE®, Ovid EMBASE and The Cochrane Library from 2000 to July 2017. Eligible studies included single arm TECAB studies as well as comparative studies (TECAB vs minimally invasive direct coronary artery bypass (MIDCAB)). Pooled event rates and odds ratios (ORs) for operative mortality, perioperative myocardial infarction (MI), perioperative stroke, graft patency and repeat revascularization were estimated. Single arm and pairwise comparisons were performed. RESULTS: Seventeen single arm TECAB articles (3721 patients, weighted mean follow-up 3.3years) were included. The pooled event rate was 0.80% (95%CI: 0.60-1.2%) for operative mortality, 2.28% (95%CI: 1.7-3%) for perioperative MI, 1.50% (95%CI: 1.1-2.0%) for perioperative stroke, 2.99% (95%CI: 1.6-5.4%) for repeat revascularization and 94.8% (95%CI: 89.3-97.5%) for early graft patency (weighted mean follow-up 10.1months). On pairwise meta-analysis 376 patients (263 TECAB and 113 MIDCAB) were included. No difference in operative mortality (OR=0.25, 95%CI: 0.02-2.83), perioperative MI (OR=3.09, 95%CI: 0.37-26.12) or perioperative stroke (OR=1.33, 95%CI: 0.17-10.26) was found between the two techniques. CONCLUSIONS: TECAB has an acceptably low operative risk and a good early patency rate. The incidence of perioperative MI requires further investigation. The dearth of data comparing TECAB to open approaches compels the need for future comparative trials.

19 Article Incomplete revascularization and long-term survival after coronary artery bypass surgery. 2018

Benedetto, Umberto / Gaudino, Mario / Di Franco, Antonino / Caputo, Massimo / Ohmes, Lucas B / Grau, Juan / Glineur, David / Girardi, Leonard N / Angelini, Gianni D. ·Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom. · Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, USA. Electronic address: mfg9004@med.cornell.edu. · Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, USA. · Division of Cardiac Surgery, Ottawa Heart Institute, Ottawa, Canada. ·Int J Cardiol · Pubmed #29407133.

ABSTRACT: BACKGROUND: We sought to investigate the impact of incomplete revascularization (IR) on long-term survival after isolated coronary artery bypass grafting (CABG). The possible interaction between IR and off-pump surgery was also explored. METHODS: A total of 13,701 patients with multivessel disease undergoing CABG were included in the analysis. All patients received left internal thoracic artery (LITA) to the left anterior descending artery (LAD) territory. IR was defined as at least one diseased arterial territory (right coronary artery [RCA] and/or circumflex [CX] artery) incompletely revascularized. RESULTS: Overall, 3107 (22.7%) patients received IR. After propensity score matching, IR did not increase all-cause death in the overall group (HR 1.09; 95%CI 0.96-1.22; P=0.17). However, when both RCA and CX artery were incompletely revascularized, late survival was significantly lower (HR 2.15; 95%CI 1.57-2.93). IR was associated with a higher risk of death after off-pump (HR 1.26; 95%CI 1.05-1.49) regardless the extent of IR. After on-pump, IR significantly affected survival only when both RCA and CX artery only were incompletely revascularized (HR 2.32; 95%CI 1.27-4.22). CONCLUSIONS: The present analysis shows that in patients with LITA-LAD graft the impact of IR on survival is marginal when only one coronary territory is left ungrafted. When both the RCA and CX territory remain unrevascularized the survival rate is significantly reduced. IR after off-pump CABG is associated with significantly lower survival and affects long-term outcome even when only one coronary territory is not revascularized.

20 Article Comparison of Outcomes for Off-Pump Versus On-Pump Coronary Artery Bypass Grafting in Low-Volume and High-Volume Centers and by Low-Volume and High-Volume Surgeons. 2018

Benedetto, Umberto / Lau, Christopher / Caputo, Massimo / Kim, Luke / Feldman, Dmitriy N / Ohmes, Lucas B / Di Franco, Antonino / Soletti, Giovanni / Angelini, Gianni D / Girardi, Leonard N / Gaudino, Mario. ·Weill Cornell Medical College, Department of Cardiothoracic Surgery, New York City, New York; Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom. · Weill Cornell Medical College, Department of Cardiothoracic Surgery, New York City, New York. · Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom. · Weill Cornell Medical College, Department of Cardiothoracic Surgery, New York City, New York. Electronic address: mfg9004@med.cornell.edu. ·Am J Cardiol · Pubmed #29291888.

ABSTRACT: In terms of in-hospital outcomes, controversy still remains whether off-pump coronary artery bypass grafting is superior to on-pump coronary artery bypass surgery. We investigated whether the volume of off-pump coronary artery bypass procedures by hospital and individual surgeon influences patient outcomes when compared with on-pump coronary artery bypass surgery. Discharge records from the Nationwide Inpatient Sample were retrospectively reviewed for in-hospital admissions from 2003 to 2011, including 999 hospitals in 44 states. A total of 2,094,094 patients undergoing on- and off-pump coronary artery bypass surgery were included. In patients requiring 2 or more grafts, off-pump coronary artery bypass compared with on-pump coronary artery bypass was associated with increased risk-adjusted mortality when performed in low-volume centers (<29 cases per year) (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.06 to 1.57) or by low-volume surgeons (<19 cases per year) (OR 1.26, 95% CI 1.02 to 1.56). In high-volume off-pump coronary artery bypass centers (≥164 cases per year) and surgeons (≥48 cases per year), off-pump coronary artery bypass reduced mortality compared with on-pump coronary artery bypass in cases requiring a single graft (OR 0.66, 95% CI 0.49 to 0.89 and OR 0.33, 95% CI 0.22 to 0.47, respectively) or 2 or more grafts (OR 0.82, 95% CI 0.66 to 0.99 and OR 0.63, 95% CI 0.49 to 0.81, respectively). In conclusion, the outcome of off-pump coronary artery bypass grafting procedures is dependent on volume at both the institution and the individual surgeon level. Off-pump coronary artery bypass should not be performed at low-volume centers and by low-volume surgeons.

21 Article How Safe Is it to Train Residents to Perform Coronary Surgery With Multiple Arterial Grafting? Nineteen Years of Training at a Single Institution. 2017

Benedetto, Umberto / Caputo, Massimo / Gaudino, Mario / Vohra, Hunaid / Chivasso, Pierpaolo / Bryan, Alan / Angelini, Gianni D. ·Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York. Electronic address: umberto.benedetto@bristol.ac.uk. · Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, UK. · Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York. ·Semin Thorac Cardiovasc Surg · Pubmed #28683990.

ABSTRACT: The learning curve of coronary artery bypass grafting (CABG) with multiple arterial grafting (MAG) is perceived to be associated with increased surgical morbidity and potentially poorer long-term outcomes. We compared short-term outcomes and long-term survival in patients who underwent CABG with MAG performed by attending surgeons or resident trainees at a single institution over a period of 19 years. Using our institutional database, we identified 3039 patients undergoing MAG from 1996-2015. Of those, 958 (32%) were operated on by residents and 2081 (68%) by attending surgeons. Propensity score matching and mixed-effects models were used to compare the 2 groups. Operative mortality rate was 0.3% and 0.4% among patients operated by residents and attending surgeons, respectively (P = 0.71), with no significant differences among the groups in postoperative complications. After a mean follow-up time of 11 ± 4 years, survival probability at 5, 10, and 15 years was 95.1% ± 0.7% vs 96.4% ± 0.6%, 87.0% ± 1.1% vs 87.8% ± 1.1%, and 76.6.% ± 1.8% vs 77.6% ± 1.8% in the resident and attending surgeon group, respectively. Resident and attending surgeon cases showed comparable risk of death (hazard ratio [HR] = 1.01; 95% CI: 0.80-1.28; P = 0.92). The equipoise between the 2 groups was confirmed among cases receiving bilateral internal thoracic arteries only (HR = 0.88; 95% CI: 0.54-1.43; P = 0.61), radial artery (HR = 1.22; 95% CI: 0.92-1.61; P = 0.15), or their combination (HR = 0.74; 95% CI: 0.33-1.65; P = 0.47). The present analysis confirms that adequately supervised trainees can perform CABG with MAG without compromising patient safety and long-term survival.

22 Article Radial Artery as a Coronary Artery Bypass Conduit: 20-Year Results. 2016

Gaudino, Mario / Tondi, Paolo / Benedetto, Umberto / Milazzo, Valentina / Flore, Roberto / Glieca, Franco / Ponziani, Francesca Romana / Luciani, Nicola / Girardi, Leonard N / Crea, Filippo / Massetti, Massimo. ·Department of Cardiovascular Sciences, Catholic University, Rome, Italy; Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York. Electronic address: mfg9004@med.cornell.edu. · Department of Cardiovascular Sciences, Catholic University, Rome, Italy. · Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom. · Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York. ·J Am Coll Cardiol · Pubmed #27491903.

ABSTRACT: BACKGROUND: There is a lack of evidence for the choice of the second conduit in coronary surgery. The radial artery (RA) is a possible option, but few data on very-long-term outcomes exist. OBJECTIVES: This study describes 20-year results of RA grafts used for coronary artery bypass grafting and the effects of RA removal on forearm circulation. METHODS: We report the results of the prospective 20-year follow-up of the first 100 consecutive patients who received the RA as a coronary bypass conduit at our institution. RESULTS: Follow-up was 100% complete. There were 64 deaths, 23 (35.9%) from cardiovascular causes. Kaplan-Meier 20-year survival was 31%. Of the 36 survivors, 33 (91.6%) underwent RA graft control at a mean of 19.0 ± 2.5 years after surgery. The RA was found to be patent in 24 cases (84.8% patency). In the overall population, probability of graft failure at 20 years was 19.0 ± 0.2% for the left internal thoracic artery (ITA), 25.0 ± 0.2% for the RA, and 55.0 ± 0.2% for the saphenous vein (p = 0.002 for RA vs. saphenous vein, 0.11 for RA vs. ITA, and p < 0.001 for ITA vs. saphenous vein). Target vessel stenosis >90%, but not location of distal anastomosis, significantly influenced long-term RA graft patency. No patients reported hand or forearm symptoms. The ulnar artery diameter was increased in the operated arm (2.44 ± 0.43 mm vs. 2.01 ± 0.47 mm; p < 0.05) and correlated with the peak systolic velocity of the second palmar digital artery (Pearson coefficient: 0.621; p < 0.05). CONCLUSIONS: The 20-year patency rate of RA grafts is good, and not inferior to the ITA, especially when the conduit is used to graft a vessel with >90% stenosis. RA harvesting does not lead to hand or forearm symptoms, even at a very-long-term follow-up.

23 Article Gender Differences in In-Hospital Outcomes After Coronary Artery Bypass Grafting. 2016

Swaminathan, Rajesh V / Feldman, Dmitriy N / Pashun, Raymond A / Patil, Rupa K / Shah, Tara / Geleris, Joshua D / Wong, Shing-Chiu / Girardi, Leonard N / Gaudino, Mario / Minutello, Robert M / Singh, Harsimran S / Bergman, Geoffrey / Kim, Luke K. ·Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York. Electronic address: rvs9001@med.cornell.edu. · Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York. · Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York. · Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York; Department of Cardiovascular Sciences, Catholic University, Rome, Italy. ·Am J Cardiol · Pubmed #27269585.

ABSTRACT: Women historically have a greater risk of operative mortality than men after coronary artery bypass grafting (CABG). There is paucity of contemporary data in gender outcomes of surgical revascularization and understanding modifiable factors that contribute to gender differences are critical for quality improvement and practice change. We, therefore, sought to examine whether the gender gap in CABG outcomes is closing in the contemporary era by conducting a retrospective analysis from the Nationwide Inpatient Sample database from 2003 to 2012. We included all patients who underwent isolated CABG surgery (n = 2,272,998; female n = 623,423 [27.4%]; male n = 1,649,575 [72.6%]). The annual rate of CABG surgeries decreased by 53.7% in men and 57.8% in women over the 10-year study period. Although internal mammary artery use in women was less frequent than in men in 2003 (77.4% vs 81.9%, p <0.001), a significant uptrend closed this gap by 2012 (86.2% vs 87.0%, ptrend 0.003). Overall, unadjusted in-hospital mortality was greater in women (3.2% vs 1.8%, p <0.001). Female gender remained an independent predictor of mortality after multivariate adjustment (odds ratio 1.40, 95% CI 1.36 to 1.43, p <0.001) across all age groups. However, in-hospital mortality decreased at a faster rate in women (3.8% to 2.7%, RR -29.1%, ptrend 0.002) than in men (2.2% to 1.6%, RR -25.7%, ptrend <0.001) from 2003 to 2012. In conclusion, CABG rates in the United States are decreasing over time, yet in-hospital mortality continues to improve. Women have worse in-hospital outcomes than men; however, the gender gap is slowly closing.

24 Article [The CORONARY study]. 2012

Massetti, Massimo / Gaudino, Mario / Stefano, Pier Luigi / Blanzola, Claudio. ·Universita Cattolica del Sacro Cuore, Roma. massettimas@yahoo.it ·G Ital Cardiol (Rome) · Pubmed #23096579.

ABSTRACT: -- No abstract --