Radial artery versus saphenous vein versus right internal thoracic artery for coronary artery bypass grafting.

Journal Article (Journal Article)

OBJECTIVES: We used individual patient data from 4 of the largest contemporary coronary bypass surgery trials to evaluate differences in long-term outcomes when radial artery (RA), right internal thoracic artery (RITA) or saphenous vein graft (SVG) 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: A total of 10 256 patients (1510 RITA; 1385 RA; 7361 SVG) were included. The matched population consisted of 1776 propensity score-matched triplets. The mean follow-up was 7.9 ± 0.1, 7.8 ± 0.1 and 7.8 ± 0.1 years in the RITA, RA and SVG cohorts respectively. All-cause mortality was significantly lower in the RA versus the SVG [hazard ratio (HR) 0.62, 95% confidence interval (CI): 0.51-0.76, P = 0.003] and the RITA group (HR 0.59, 95% CI 0.48-0.71, P = 0.001). Major adverse cardiac and cerebrovascular event rate was also lower in the RA group versus the SVG (HR 0.78, 95% CI 0.67-0.90, P = 0.04) and the RITA 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 4 large coronary bypass surgery trials, the use of the RA was associated with better clinical outcomes when compared to SVG and RITA.

Full Text

Duke Authors

Cited Authors

  • Gaudino, M; Audisio, K; Di Franco, A; Alexander, JH; Kurlansky, P; Boening, A; Chikwe, J; Devereaux, PJ; Diegeler, A; Dimagli, A; Flather, M; Lamy, A; Lawton, JS; Tam, DY; Reents, W; Rahouma, M; Girardi, LN; Hare, DL; Fremes, SE; Benedetto, U

Published Date

  • June 15, 2022

Published In

Volume / Issue

  • 62 / 1

PubMed ID

  • 35678560

Electronic International Standard Serial Number (EISSN)

  • 1873-734X

Digital Object Identifier (DOI)

  • 10.1093/ejcts/ezac345


  • eng

Conference Location

  • Germany