Association between sternal wound complications and 10-year mortality following coronary artery bypass grafting

Mario Gaudino*, Katia Audisio, Mohamed Rahouma, N. Bryce Robinson, Giovanni J. Soletti, Gianmarco Cancelli, Ruth M. Masterson Creber, Alastair Gray, Belinda Lees, Stephen Gerry, Umberto Benedetto, Marcus Flather, David P. Taggart, Arterial Revascularization Trial Investigators, S. Clark

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)532-539.e4
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number2
Early online date24 Dec 2021
Publication statusPublished - 1 Aug 2023

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