Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events

N Engl J Med. 1986 Jan 2;314(1):1-6. doi: 10.1056/NEJM198601023140101.


We compared patients who received an internal-mammary-artery graft to the anterior descending coronary artery alone or combined with one or more saphenous-vein grafts (n = 2306) with patients who had only saphenous-vein bypass grafts (n = 3625). The 10-year actuarial survival rate among the group receiving the internal-mammary-artery graft, as compared with the group who received the vein grafts (exclusive of hospital deaths), was 93.4 percent versus 88.0 percent (P = 0.05) for those with one-vessel disease; 90.0 percent versus 79.5 percent (P less than 0.0001) for those with two-vessel disease; and 82.6 percent versus 71.0 percent (P less than 0.0001) for those with three-vessel disease. After an adjustment for demographic and clinical differences by Cox multivariate analysis, we found that patients who had only vein grafts had a 1.61 times greater risk of death throughout the 10 years, as compared with those who received an internal-mammary-artery graft. In addition, patients who received only vein grafts had 1.41 times the risk of late myocardial infarction (P less than 0.0001), 1.25 times the risk of hospitalization for cardiac events (P less than 0.0001), 2.00 times the risk of cardiac reoperation (P less than 0.0001), and 1.27 times the risk of all late cardiac events (P less than 0.0001), as compared with patients who received internal-mammary-artery grafts. Internal-mammary-artery grafting for lesions of the anterior descending coronary artery is preferable whenever indicated and technically feasible.

Publication types

  • Comparative Study

MeSH terms

  • Coronary Artery Bypass / adverse effects
  • Coronary Artery Bypass / mortality
  • Female
  • Follow-Up Studies
  • Graft Occlusion, Vascular
  • Heart Diseases / epidemiology*
  • Humans
  • Internal Mammary-Coronary Artery Anastomosis / adverse effects
  • Internal Mammary-Coronary Artery Anastomosis / methods
  • Internal Mammary-Coronary Artery Anastomosis / mortality*
  • Male
  • Middle Aged
  • Myocardial Revascularization / mortality*
  • Postoperative Complications / epidemiology*
  • Recurrence
  • Reoperation
  • Saphenous Vein / transplantation