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Radial Artery vs. SVG Among Patients Undergoing CABG
Quick Takes
- Use of the radial artery for CABG was associated with a lower incidence of the composite of cardiovascular outcomes.
- It seems reasonable to consider the radial artery over a vein graft for CABG when feasible.
- The ongoing ROMA (Randomized Comparison of the Outcome of Single vs. Multiple Arterial Grafts) trial will provide additional insight on potential benefits of multiple arterial grafts including an effect on mortality.
Study Questions:
What are the clinical outcomes between patients receiving radial artery versus saphenous vein grafts (SVGs) for coronary artery bypass grafting (CABG) after long-term follow-up?
Methods:
The investigators conducted a patient-level pooled analysis comparing radial artery versus SVG in adult patients undergoing isolated CABG from five countries (Australia, Italy, Serbia, South Korea, and the United Kingdom), with enrollment from 1997-2009 and follow-up completed in 2019. Patients were randomized to undergo either radial artery (n = 534) or saphenous vein (n = 502) grafts for CABG. The primary outcome was a composite of death, myocardial infarction (MI), or repeat revascularization and the secondary outcome was a composite of death or MI. Association between treatment and outcomes was estimated with a mixed-effect Cox regression model, with treatment allocation included as fixed effect and trial identifiers included as random effect.
Results:
A total of 1,036 patients were randomized (mean age, 66.6 years in the radial artery group vs. 67.1 years in the saphenous vein group; 376 [70.4%] men in the radial artery group vs. 351 [69.9%] in the saphenous vein group); 942 (90.9%) of the originally randomized patients completed 10 years of follow-up (510 in the radial artery group). At a median (interquartile range) follow-up of 10 (10-11) years, the use of the radial artery, compared with the saphenous vein, in CABG was associated with a statistically significant reduction in the incidence of the composite outcome of death, MI, or repeat revascularization (220 vs. 237 total events; 41 vs. 47 events per 1,000 patient-years; hazard ratio, 0.73; 95% confidence interval, 0.61-0.88; p < 0.001) and of the composite of death or MI (188 vs. 193 total events; 35 vs. 38 events per 1,000 patient-years; hazard ratio, 0.77; 95% confidence interval, 0.63-0.94; p = 0.01).
Conclusions:
The authors concluded that among patients undergoing CABG, the use of the radial artery compared with the saphenous vein was associated with a lower risk of a composite of cardiovascular outcomes.
Perspective:
This patient-level analysis of five randomized controlled trials with a median follow-up of 10 years reports that the use of the radial artery for CABG was associated with a lower incidence of the composite outcomes of death, MI, or repeat revascularization and of death or MI compared with the use of the SVG. Furthermore, in a post hoc analysis, the use of the radial artery was also associated with a significantly lower incidence of death. While the results of the ongoing ROMA (Randomized Comparison of the Outcome of Single vs Multiple Arterial Grafts) trial (ClinicalTrials.gov, 1703018094) will provide additional insight on potential benefits of multiple arterial grafts, it seems reasonable to consider the radial artery as bypass conduit for CABG when feasible and appropriate.
Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias, Interventions and ACS
Keywords: Acute Coronary Syndrome, Coronary Artery Bypass, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Radial Artery, Saphenous Vein, Secondary Prevention, Treatment Outcome
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