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Massimo Caputo
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J Thorac Cardiovasc Surg 2004;127:894-895
© 2004 The American Association for Thoracic Surgery

Letter to the editor

Reply to the Editor

Barnaby Reeves, PhD, Massimo Caputo, MD, Gianni D. Angelini, MD

Bristol Heart Institute, University of Bristol, Bristol , United Kingdom

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

In this issue, Buxton and colleagues comment on 2 recent articles in the Journal reporting evidence about the effects of choosing the right internal thoracic artery (RITA) or radial artery (RA) for the second arterial conduit for bypass grafting. The 2 articles reported interim results of a randomized controlled trial (RCT)1 and a nonrandomized study (NRS).2

Buxton and colleagues advance several alternative explanations to reconcile the apparently conflicting findings of the two studies: (1) There were differences in study design, that is, the greater susceptibility, in general, of observational data to bias. (2) Specifically, there was the possibility of inadequate control in the observational study for differences between groups in graft site and grafting strategy. (3) There was a short duration of follow-up in the observational study. (4) A composite outcome (survival free from cardiac-related events) was used in the observational study. (5) The findings are, in fact, consistent with one another given the imprecision of the findings of both studies.

In the absence of data from well-conducted RCTs with sufficient duration of follow-up, it is not possible to distinguish between these options; the last one is, arguably, the most parsimonious. As we stated,2 such a trial is the . . . [Full Text of this Article]






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