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J Thorac Cardiovasc Surg 2004;127:893-894
© 2004 The American Association for Thoracic Surgery

Letter to the editor

Reply to the Editor

Brian F. Buxton, MD, Rinaldo Bellomo, MD, Ian Gordon, PhD, AStat, David L. Hare, MD

Austin Hospital, Melbourne , Australia

The first 20% of the full text of this article appears below.

The choice between the right internal thoracic artery (RITA) or radial artery (RA) for the second coronary artery bypass conduit remains hotly debated, as evidenced by 2 recent publications in the Journal, one a randomized controlled trial1 and the other a retrospective observational study.2

The interim 5-year result of our randomized controlled study suggested that the clinical outcomes of the RITA and the RA groups were similar. This differed from the conclusion drawn from the cohort study reported by Caputo and colleagues,2 which suggested a clinical benefit from using the RA compared with the RITA. It is important to consider possible reasons for such an apparent difference in conclusions.

Caputo and colleagues' study2 differed from the randomized trial. There was no assessment of graft patency, and they included additional end points. Obviously, cohort studies can never control for unrecognized factors. Therefore, an observational study should always be regarded as providing less reliable evidence than a randomized trial.3 This has recently been highlighted by the complete reversal of opinion as to the benefits of hormone replacement therapy once the results of randomized trials became available. One important factor that may not be well controlled in an observational study of this sort is the surgeon. The choice of graft was "entirely at the discretion of the surgeon." If some surgeons strongly preferred one type of operation, or even used it exclusively, this means that the comparison based on the . . . [Full Text of this Article]




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