Time-varying survival benefit of radial artery versus vein grafting: a multiinstitutional analysis
Thomas A Schwann1, Robert F Tranbaugh2, Kamellia R Dimitrova2
1Department of Surgery, University of Toledo Medical Center, Toledo, Ohio; Mercy Saint Vincent Medical Center, Toledo, Ohio.
Insights
Radial artery grafting offers a survival advantage in coronary artery bypass grafting (CABG). This benefit, observed in two independent studies, is most pronounced between 0.5 and 5 years after surgery.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Outcomes Research
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for severe coronary artery disease.
- The choice of arterial or venous conduits for bypass grafting impacts long-term patient survival.
- Previous studies suggest a survival benefit associated with using radial artery grafts compared to saphenous vein grafts.
Purpose of the Study:
- To investigate the time-dependent survival benefit of radial artery grafts versus saphenous vein grafts in CABG.
- To compare these benefits across two independent patient cohorts from different institutions.
- To provide robust evidence supporting the optimal choice of graft material for CABG.
Main Methods:
- Comparison of 0- to 15-year survival data from two independent CABG series (Ohio and New York).
- Utilized propensity score matching to create comparable cohorts based on demographic and clinical factors.
- Employed a three-phase mortality model to analyze time-varying survival benefits and derive hazard functions.
Main Results:
- Both institutions demonstrated significantly better cumulative survival with radial artery grafts compared to saphenous vein grafts (p < 0.001).
- The time-varying survival benefit of radial artery grafts was consistent across both independent cohorts.
- Maximal survival advantage for radial artery grafts was observed between 0.5 and 5 years post-CABG.
Conclusions:
- Radial artery grafting provides a significant and consistent survival advantage in CABG patients.
- This benefit is time-dependent, with the greatest impact observed in the early to mid-term post-operative period.
- Findings from two independent, propensity-matched cohorts strengthen the evidence for radial artery use in CABG.
Background:
A survival benefit of radial artery use versus saphenous vein grafting in coronary artery bypass grafting (CABG) has been reported. We aimed to elucidate the relative radial artery survival benefit as a function of time after surgery from two independent CABG series.
Methods:
We compared 0- to 15-year survival with radial artery versus saphenous vein grafting in isolated, nonsalvage primary CABG with left internal thoracic artery to left anterior descending from two institutions: Ohio (radial artery [n=2,361; 61 years]; saphenous vein [n=2,547; 67 years]), and New York (radial artery [n=1,970; 58 years]; saphenous vein [n=2,974; 69 years]). Separate multivariate radial artery-use propensity models based on demographic, preoperative factors, intraoperative variables, and completeness of revascularization data were computed and used to derive propensity- and sex-matched CABG cohorts (1,799 [Ohio] and 995 [New York] pairs). A three-phase (early and late) mortality model was fit to Kaplan-Meier mortality estimates and used to derive relative radial artery versus saphenous vein hazard functions.
Results:
Radial artery use patterns and patient risk profiles differed substantially for New York and Ohio, with the New York radial artery cohort significantly younger and more male. Within-institution matched graft-type cohorts were well matched. Cumulative mortality was significantly better for radial artery at both institutions (p < 0.001 both). All mortality-time data were well described by the three-phase model, and the derived relative hazard functions were qualitatively and quantitatively similar for New York and Ohio, exhibiting maximal benefit between 0.5 and 5 years.
Conclusions:
Despite substantial differences in radial artery use patterns during a 15-year period, our analysis in large propensity-matched radial artery and saphenous vein cohorts yielded remarkably similar, time-varying radial artery to saphenous vein survival benefit at both institutions. These converging findings based on two independent patient series extend currently available objective evidence in support of a radial artery survival advantage in CABG.
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