Mid-term results of the Radial Artery Patency and Clinical Outcomes randomized trial

The radial artery (RA), as an alternative to the saphenous vein or the right internal thoracic artery (RITA) for coronary artery bypass grafting, has gained considerable interest over the years. A randomized controlled trial was undertaken to assess the suitability of the radial artery as a conduit.

The Radial Artery Patency and Clinical Outcomes (RAPCO) trial is a double-armed randomized controlled trial comparing the RA with the free RITA in a younger cohort of patients undergoing elective coronary bypass surgery, and the RA with the saphenous vein in an older group. The trial conduit was grafted to the most important coronary target after the left anterior descending artery, which received the gold standard left internal thoracic artery. Clinical outcomes and angiographic patency up to 10 years was recorded during careful follow up, with annual clinical review and a program of randomly assigned, staggered angiography. The final trial results will be available in 2014.

Mid-trial results have shown equivalent survival and event-free survival and graft patency in both arms at median follow up of approximately 6 years. The demographic and clinical data, pre- and postoperative angiographic findings of the trial database have led to a number of substudies focusing on the role of lipid exposure in patency and disease progression, the fate of moderate lesions when grafted or left alone, patterns of disease regression, and patient satisfaction with graft harvest sites.

While the final analysis of the primary trial end points is eagerly awaited, the additional insight into the natural history of grafted coronary artery disease with modern secondary prevention will be of considerable interest.