May - 2018
Showing Journal 5 of 5
Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery
New Eng J Med, 2018, online first April 2018
The debate about the benefit and risk of radial vs SV grafts, in addition to internal-thoracic graft to LAD, has been ongoing. Although angiographic studies have reported higher rates of radial graft patency, these have been underpowered to detect differences in clinical events. Although guidelines support the use of multiple arterial grafts, the great majority of patients in North America and Europe receive SVGs + ITA.
This study utilised the Radial Artery Database International Alliance (RADIAL), and performed a patient level combined analysis comparing 6 randomized, controlled trials in which long-term outcomes were assessed, and reported outcomes in radial-artery grafts and saphenous-vein grafts for CABG.
Overall radial vs saphenous graft was associated with lower rate of cardiac adverse events, particularly AMI and need for revascularisation, and lower rate of graft occlusion at 5-years. There was no difference in survival, and sub-group analysis suggests certain populations are likely to benefit more from radial grafts.
The use of radial-artery grafts for coronary-artery bypass grafting (CABG) may result in better postoperative outcomes than the use of saphenous-vein grafts. However, randomized, controlled trials comparing radial-artery grafts and saphenous-vein grafts have been individually underpowered to detect differences in clinical outcomes. We performed a patient-level combined analysis of randomized, controlled trials to compare radial-artery grafts and saphenous-vein grafts for CABG.
Six trials were identified. The primary outcome was a composite of death, myocardial infarction, or repeat revascularization. The secondary outcome was graft patency on follow-up angiography. Mixed-effects Cox regression models were used to estimate the treatment effect on the outcomes.
A total of 1036 patients were included in the analysis (534 patients with radial-artery grafts and 502 patients with saphenous-vein grafts). After a mean (±SD) follow-up time of 60±30 months, the incidence of adverse cardiac events was significantly lower in association with radial-artery grafts than with saphenous-vein grafts (hazard ratio, 0.67; 95% confidence interval [CI], 0.49 to 0.90; P=0.01). At follow-up angiography (mean follow-up, 50±30 months), the use of radial-artery grafts was also associated with a significantly lower risk of occlusion (hazard ratio, 0.44; 95% CI, 0.28 to 0.70; P<0.001). As compared with the use of saphenous-vein grafts, the use of radial-artery grafts was associated with a nominally lower incidence of myocardial infarction (hazard ratio, 0.72; 95% CI, 0.53 to 0.99; P=0.04) and a lower incidence of repeat revascularization (hazard ratio, 0.50; 95% CI, 0.40 to 0.63; P<0.001) but not a lower incidence of death from any cause (hazard ratio, 0.90; 95% CI, 0.59 to 1.41; P=0.68).
As compared with the use of saphenous-vein grafts, the use of radial-artery grafts for CABG resulted in a lower rate of adverse cardiac events and a higher rate of patency at 5 years of follow-up.
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