Skeletonized bilateral internal mammary arteries for non-elective surgical revascularization in unstable angina

Objective: The aim of this study was to evaluate the feasibility, safety and outcome of skeletonized bilateral internal mammary arteries (BIMA) in patients with unstable angina (UA) undergoing non-elective myocardial revascularization. Methods: Between January 1997 and December 2003, 758 patients, mean age 62G12 years, underwent non-elective coronary artery bypass grafting (CABG) for unstable angina. Two hundred and five (27%) were operated emergently and 503 (73%) urgently. BIMA were employed in 320 (42%) patients (Group B) and isolated left IMA and/or saphenous vein grafts in the remaining 438 (58%) patients (Group M). Results: In-hospital mortality (BZ5.9% and MZ5.3%), and perioperative myocardial infarction (BZ2.2%; MZ1.96%) were similar between the two groups (PZns). Actuarial survival at 1, 3 and 7 years was 98.7, 97.5 and 96.2% in B and 99, 94.3 and 88.4% in M (P!0.05 at 7 years follow-up). At 7 years follow-up, the event-free cardiac survival (92 vs. 87%, PZ0.021), angina-free survival (98.6 vs. 94%, PZ0.039), reoperation-free cardiac survival (98 vs. 95%, PZ0.04) and infarct-free cardiac survival (98.7 vs. 96%, PZ0.05) were better in Group B. Multivariate analysis identified ageO65 years (PZ0.02), LVEF!35% (PZ0.01), O1 ischemic irreversible area (PZ0.03) as independent predictors for late deaths, while the use of the LIMA (PZ0.006) and both mammary arteries (PZ0.001) decreased the risk of late deaths. Conclusions: The use of BIMA in non-elective CABG for UA is safe and effective. Mid-term outcome, however, are superior with improved freedom from cardiac death, from coronary reintervention and from myocardial infarction. Q 2005 Elsevier B.V. All rights reserved.