Radial artery versus saphenous vein versus right internal thoracic artery for coronary artery bypass grafting.
Academic Article
Overview
abstract
OBJECTIVES: We used individual patient data from four of the largest contemporary coronary bypass surgery trials to evaluate differences in long-term outcomes when radial artery, right internal thoracic artery, or saphenous vein graft are used to complement the left internal thoracic artery-to-left anterior descending graft. METHODS: Primary outcome was all-cause mortality. Secondary outcome was a composite of major adverse cardiac and cerebrovascular events (all-cause mortality, myocardial infarction, and stroke). Propensity score matching and Cox regression were used to reduce the effect of treatment selection bias and confounders. RESULTS: 10,256 patients (1510 right internal thoracic artery; 1385 radial artery; 7361 saphenous vein graft) were included. The matched population consisted of 1776 propensity score-matched triplets. Mean follow-up was 7.9 ± 0.1, 7.8 ± 0.1, and 7.8 ± 0.1 years in the right internal thoracic artery, radial artery, and saphenous vein graft cohorts respectively. All-cause mortality was significantly lower in the radial artery vs the saphenous vein graft (HR 0.62, 95% CI: 0.51-0.76, p = 0.003) and the right internal thoracic artery group (HR 0.59, 95% CI 0.48-0.71, p = 0.001). Major adverse cardiac and cerebrovascular events rate was also lower in the radial artery group vs the saphenous vein graft (HR 0.78, 95% CI 0.67-0.90, p = 0.04) and the right internal thoracic artery group (HR 0.75, 95% CI 0.65-0.86, p = 0.02). Results were consistent in the Cox-adjusted analysis and solid to hidden confounders. CONCLUSIONS: In this pooled analysis of four large coronary bypass surgery trials, the use of the radial artery was associated with better clinical outcomes when compared to saphenous vein graft and right internal thoracic artery.
