TY - JOUR
T1 - Association between sternal wound complications and 10-year mortality following coronary artery bypass grafting
AU - Gaudino, Mario
AU - Audisio, Katia
AU - Rahouma, Mohamed
AU - Robinson, N. Bryce
AU - Soletti, Giovanni J.
AU - Cancelli, Gianmarco
AU - Masterson Creber, Ruth M.
AU - Gray, Alastair
AU - Lees, Belinda
AU - Gerry, Stephen
AU - Benedetto, Umberto
AU - Flather, Marcus
AU - Taggart, David P.
AU - Arterial Revascularization Trial Investigators
AU - Clark, S.
PY - 2023/8/1
Y1 - 2023/8/1
N2 - Objective: To evaluate the association between sternal wound complications (SWC) and long-term mortality in the Arterial Revascularization Trial. Methods: Participants in the Arterial Revascularization Trial were stratified according to the occurrence of postoperative SWC. The primary outcome was all-cause mortality at long-term follow-up. The secondary outcome was major adverse cardiovascular events. Results: Three thousand one hundred two patients were included in the analysis; the median follow-up was 10 years. 115 patients (3.7%) had postoperative SWC: 85 (73.9%) deep sternal wound infections and 30 (26.1%) sterile SWC that required sternal reconstruction. Independent predictors of SWC included diabetes (odds ratio [OR], 2.77; 95% CI, 1.79-4.30; P < .001), female sex (OR, 2.73; 95% CI, 1.71-4.38; P < .001), prior stroke (OR, 2.59; 95% CI, 1.12-5.98; P = .03), chronic obstructive pulmonary disease (OR, 2.44; 95% CI, 1.60-3.71; P < .001), and use of bilateral internal thoracic artery (OR, 1.70; 95% CI, 1.12-2.59; P = .01). Postoperative SWC was significantly associated with long-term mortality. The Kaplan-Meier survival estimate was 91.3% at 5 years and 79.4% at 10 years in patients without SWC, and 86.1% and 64.3% in patients with SWC (log rank P < .001). The rate of major adverse cardiovascular events was also higher among patients who had SWC (n = 51 [44.3%] vs 758 [25.4%]; P < .001). Using multivariable analysis, the occurrence of SWC was independently associated with long-term mortality (hazard ratio, 1.81; 95% CI, 1.30-2.54; P < .001). Conclusions: In the Arterial Revascularization Trial, postoperative SWC although uncommon were significantly associated with long-term mortality.
AB - Objective: To evaluate the association between sternal wound complications (SWC) and long-term mortality in the Arterial Revascularization Trial. Methods: Participants in the Arterial Revascularization Trial were stratified according to the occurrence of postoperative SWC. The primary outcome was all-cause mortality at long-term follow-up. The secondary outcome was major adverse cardiovascular events. Results: Three thousand one hundred two patients were included in the analysis; the median follow-up was 10 years. 115 patients (3.7%) had postoperative SWC: 85 (73.9%) deep sternal wound infections and 30 (26.1%) sterile SWC that required sternal reconstruction. Independent predictors of SWC included diabetes (odds ratio [OR], 2.77; 95% CI, 1.79-4.30; P < .001), female sex (OR, 2.73; 95% CI, 1.71-4.38; P < .001), prior stroke (OR, 2.59; 95% CI, 1.12-5.98; P = .03), chronic obstructive pulmonary disease (OR, 2.44; 95% CI, 1.60-3.71; P < .001), and use of bilateral internal thoracic artery (OR, 1.70; 95% CI, 1.12-2.59; P = .01). Postoperative SWC was significantly associated with long-term mortality. The Kaplan-Meier survival estimate was 91.3% at 5 years and 79.4% at 10 years in patients without SWC, and 86.1% and 64.3% in patients with SWC (log rank P < .001). The rate of major adverse cardiovascular events was also higher among patients who had SWC (n = 51 [44.3%] vs 758 [25.4%]; P < .001). Using multivariable analysis, the occurrence of SWC was independently associated with long-term mortality (hazard ratio, 1.81; 95% CI, 1.30-2.54; P < .001). Conclusions: In the Arterial Revascularization Trial, postoperative SWC although uncommon were significantly associated with long-term mortality.
KW - coronary artery bypass grafting
KW - long-term mortality
KW - sternal wound complications
UR - http://www.scopus.com/inward/record.url?scp=85123092052&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2021.10.067
DO - 10.1016/j.jtcvs.2021.10.067
M3 - Article
C2 - 35063171
AN - SCOPUS:85123092052
SN - 0022-5223
VL - 166
SP - 532-539.e4
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 2
ER -
