Background: Variation in size of the internal mammary artery has been demonstrated in ethnic groups, but not reported in Aboriginal patients. We hypothesised that the left internal mammary artery is smaller in Aboriginal patients compared to non-Aboriginal patients and aimed to determine the impact on survival following coronary artery bypass graft (CABG) surgery.
Methods: Left internal mammary artery size was compared between Aboriginal (n = 345) and non-Aboriginal (n = 1819) in 2343 patients undergoing CABG at Flinders Medical Centre from January 2010 to June 2021. To determine the association with-survival we used Kaplan–Meier survival analysis and Cox proportional hazard models adjusted for preoperative variables.
Results: There was a significant difference in left internal mammary artery (LIMA) size—Aboriginal 1.8 ± 0.4 mm; non-Aboriginal 2.1 ± 0.4 mm (P < 0.001)—and left anterior descending (LAD) artery size—Aboriginal 1.7 ± 0.3 mm; non-Aboriginal 1.9 ± 0.3 mm (P < 0.001). Aboriginal patients were more likely to have the LIMA discarded (9.3% vs. 0.4%) and to receive a LAD vein graft (17% versus 3%) (P < 0.001). There was no difference in 30-day mortality or survival <5 years.
Conclusion: This study supports the hypothesis that the left internal mammary artery is smaller in Aboriginal patients compared to non-Aboriginal patients. Although Aboriginal patients were more likely to receive a venous conduit to the LAD, we observed no difference in survival up to 5 years. This data contrasts with reported outcomes of other ethnic groups.
|Number of pages||7|
|Journal||ANZ Journal of Surgery|
|Early online date||2 Nov 2022|
|Publication status||Published - Dec 2022|
- Aboriginal and Torres Strait islander
- conduit selection
- coronary artery bypass graft
- internal mammary artery