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Published on: November 11, 2012
The radial artery versus the saphenous vein graft in contemporary CABG: a case-matched study
G Cohen1, M G Tamariz, J Y Sever
1Division of Cardiovascular Surgery, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
Insights
Radial artery (RA) grafting improves outcomes in coronary artery bypass grafting (CABG) surgery. Despite higher comorbidities, RA grafts offer protection against early and late mortality, morbidity, and reintervention, showing superior long-term event-free survival.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Surgical Outcomes
Background:
- Internal thoracic artery grafting improves CABG outcomes.
- The benefit of radial artery (RA) grafting requires further investigation.
- This study evaluates RA as an arterial conduit in CABG.
Purpose of the Study:
- To determine the benefit of radial artery (RA) grafting in coronary artery bypass grafting (CABG).
- To compare outcomes between patients receiving RA grafts and those receiving only saphenous vein grafts (SVGs).
Main Methods:
- A case-matched review of 2,847 patients undergoing isolated CABG between March 1994 and March 1999.
- 478 patients received an RA graft alongside left internal thoracic artery and SVGs (RA group).
- RA patients were matched 1:2 with 956 patients receiving only left internal thoracic artery and SVGs (SVG group) based on six prognostic factors.
Main Results:
- The RA group had a higher prevalence of diabetes, hypertension, and peripheral vascular disease.
- RA grafting was associated with shorter ICU stays, reduced perioperative myocardial infarction, and protection against early and late mortality/morbidity.
- 36-month actuarial freedom from events was significantly greater in the RA group (95% ± 2%) compared to the SVG group (86% ± 4%).
Conclusions:
- Radial artery grafting leads to improved patient outcomes after coronary artery bypass grafting.
- The RA is a viable and beneficial arterial conduit for CABG surgery.
- RA grafting demonstrates protective effects against mortality, morbidity, and reintervention, even in patients with comorbidities.
Background:
Although use of the internal thoracic artery has been shown to improve outcomes after coronary artery bypass grafting, the same cannot be said of alternative arterial conduits. To determine the benefit of radial artery (RA) grafting, a case-matched review was undertaken.
Methods:
Between March 1994 and March 1999, 2,847 patients underwent isolated coronary artery bypass grafting with a left internal thoracic artery graft, plus saphenous vein grafts (SVGs). Of these patients, 478 also received an RA graft (RA group). The RA patients were matched at a ratio of 1:2 with patients receiving only SVGs and a left internal thoracic artery graft (SVG group; n = 956) using six prognostic risk factors: age, sex, Canadian Cardiovascular Society class, left ventricular grade, number of diseased vessels, and timing of operation. Target vessels were graded according to quality and graftability and were similar between groups. Outcomes were evaluated by univariate and multivariate analyses.
Results:
There was a significantly higher prevalence of diabetes, hypertension, and peripheral vascular disease in the RA group (p < 0.05). Although stay in the intensive care unit was shorter in the RA group (RA, 30 +/- 2 hours, and SVG, 37 +/- 2 hours; p = 0.0002), total hospital stay was similar between groups. The incidence of perioperative myocardial infarction was higher in the SVG group (SVG, 31 of 956 or 3.2%, and RA, 6 of 478 or 1.3%; p = 0.02). Multivariate analysis revealed RA grafting to be protective against early mortality and morbidity (odds ratio = 0.58; 95% confidence interval, 0.37 to 0.90; p = 0.015) and late mortality and morbidity including late reintervention (risk ratio = 0.60; 95% confidence interval, 0.37 to 0.93; p = 0.02). Actuarial freedom from events at 36 months postoperatively was greater in the RA group (RA, 95% +/- 2%, and SVG, 86% +/- 4%; p = 0.01).
Conclusions:
Despite a higher prevalence of preoperative comorbidity, patients in the RA group demonstrated improved outcomes after coronary artery bypass grafting. The RA is a viable and beneficial conduit for this operation.
