Radial Artery Patency and Clinical Outcomes Study–Right Internal Thoracic Artery - RAPCO-RITA

Nov 06, 2022
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Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
Heart Foundation (Australia)
Date Presented:
11/06/2022
Date Published:
11/06/2022
Original Posted Date:
11/06/2022
References

Contribution To Literature:

The RAPCO-RITA trial showed that a radial artery bypass graft improves adverse cardiovascular outcomes compared with a right internal thoracic artery bypass graft.

Description:

The goal of the trial was to evaluate a radial artery bypass graft compared with a free right thoracic internal artery bypass graft among patients undergoing coronary artery bypass graft (CABG) surgery.

Study Design

  • Randomized
  • Parallel

Patients undergoing CABG were randomized to a radial artery bypass graft (n = 198) versus a free right internal thoracic artery bypass graft (n = 196). The left internal thoracic artery to the left anterior descending artery was considered standard of care for all participants. Randomization was applied to the second bypass graft.

  • Total number of enrollees: 394
  • Duration of follow-up: 16.5 years
  • Mean patient age: 60 years
  • Percentage female: 9%
  • Percentage with diabetes: 11%

Inclusion criteria:

  • Patients <70 years or <60 years with diabetes undergoing CABG with ≥2 bypass grafts

Exclusion criteria:

  • Small radial artery or poor flow in the ulnar artery
  • Left ventricular ejection fraction <35%
  • Advanced chronic kidney disease
  • FEV1 <1 L
  • Body mass index >35 kg/m2

Other salient features/characteristics:

  • Mean number of grafts, 3.2

Principal Findings:

The primary outcome, all-cause mortality, myocardial infarction, or repeat revascularization, occurred in 39.4% of the radial artery bypass group vs. 48.5% of the right internal thoracic artery bypass group (p = 0.04).

Secondary outcomes:

  • Mortality: 22.2% of the radial artery group vs. 30.1% of the right internal thoracic artery group (p = 0.06)
  • Repeat revascularization: 18.6% of the radial artery group vs. 21.4% of the right internal thoracic artery group (p = 0.30)

Interpretation:

Among patients undergoing CABG, the radial artery bypass graft was associated with improved outcomes compared with a free right internal thoracic artery bypass graft. There were numerically fewer deaths in the radial artery bypass graft group. Further research is needed to determine if an instrumented radial artery can serve as a satisfactory bypass conduit.

References:

Presented by Dr. David L. Hare at the American Heart Association Scientific Sessions, Chicago, IL, November 6, 2022.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and Arrhythmias, Cardiac Surgery and SIHD

Keywords: AHA Annual Scientific Sessions, AHA22, Angina Pectoris, Cardiac Surgical Procedures, Coronary Artery Bypass, Diabetes Mellitus, Geriatrics, Mammary Arteries, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Radial Artery, Standard of Care, Thoracic Surgery


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