Radial Artery Graft and Clinical Outcomes

Study Questions:

What are the associations between the use of a radial artery (RA) graft when used to supplement either single left internal thoracic artery (SITA) or bilateral internal thoracic artery (BITA) grafts and clinical outcomes?

Methods:

Patients enrolled in the ART (Arterial Revascularization Trial) (n = 3,102) were classified based on conduits actually received (as treated). The analysis included 2,737 patients who received an RA graft (RA group, n = 632) or saphenous vein graft (SVG) only (SVG group, n = 2,105) in addition to SITA or BITA grafts. The primary endpoint was the composite of myocardial infarction, cardiovascular death, and repeat revascularization at 5 years. Propensity score matching and stratified Cox regression were used to compare the two strategies.

Results:

Myocardial infarction, cardiovascular death, and repeat revascularization cumulative incidence was 2.3% (95% confidence interval [CI], 1.1-3.4), 3.5% (95% CI, 2.1-5.0), and 4.4% (95% CI, 2.8-6.0) in the RA group and 3.4% (95% CI, 2.0-4.8), 4.0% (95% CI, 2.5-5.6), and 7.6% (95% CI, 5.5-9.7) in the SVG group, respectively. The composite endpoint was significantly lower in the RA group (8.8%; 95% CI, 6.5-11.0) when compared with the SVG group (13.6%; 95% CI, 10.8-16.3) (p = 0.005). This association was present when an RA graft was used to supplement both SITA and BITA grafts (interaction p = 0.62).

Conclusions:

The authors concluded that an additional RA was associated with lower risk for mid-term major adverse cardiac events when used to supplement SITA or BITA grafts.

Perspective:

This study reports that an additional RA graft was associated with lower risk for mid-term major adverse cardiac events when used to supplement SITA or BITA grafts. Technically, the RA graft is simple to perform, as its caliber and handling properties are similar to vein grafts. Based on these and other available data, it seems quite reasonable to consider the use of an RA graft a valid option for multiple arterial grafting.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention

Keywords: Cardiac Surgical Procedures, Coronary Artery Bypass, Mammary Arteries, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Radial Artery, Saphenous Vein, Treatment Outcome


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