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Published on: March 27, 2018
Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery
Mario Gaudino1, Umberto Benedetto1, Stephen Fremes1
1From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York; Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom; Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.); the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy; the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia; Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.); and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.).
Background:
The use of radial-artery grafts for coronary-artery bypass grafting (CABG) may result in better postoperative outcomes than the use of saphenous-vein grafts. However, randomized, controlled trials comparing radial-artery grafts and saphenous-vein grafts have been individually underpowered to detect differences in clinical outcomes. We performed a patient-level combined analysis of randomized, controlled trials to compare radial-artery grafts and saphenous-vein grafts for CABG.
Methods:
Six trials were identified. The primary outcome was a composite of death, myocardial infarction, or repeat revascularization. The secondary outcome was graft patency on follow-up angiography. Mixed-effects Cox regression models were used to estimate the treatment effect on the outcomes.
Results:
A total of 1036 patients were included in the analysis (534 patients with radial-artery grafts and 502 patients with saphenous-vein grafts). After a mean (±SD) follow-up time of 60±30 months, the incidence of adverse cardiac events was significantly lower in association with radial-artery grafts than with saphenous-vein grafts (hazard ratio, 0.67; 95% confidence interval [CI], 0.49 to 0.90; P=0.01). At follow-up angiography (mean follow-up, 50±30 months), the use of radial-artery grafts was also associated with a significantly lower risk of occlusion (hazard ratio, 0.44; 95% CI, 0.28 to 0.70; P<0.001). As compared with the use of saphenous-vein grafts, the use of radial-artery grafts was associated with a nominally lower incidence of myocardial infarction (hazard ratio, 0.72; 95% CI, 0.53 to 0.99; P=0.04) and a lower incidence of repeat revascularization (hazard ratio, 0.50; 95% CI, 0.40 to 0.63; P<0.001) but not a lower incidence of death from any cause (hazard ratio, 0.90; 95% CI, 0.59 to 1.41; P=0.68).
Conclusions:
As compared with the use of saphenous-vein grafts, the use of radial-artery grafts for CABG resulted in a lower rate of adverse cardiac events and a higher rate of patency at 5 years of follow-up. (Funded by Weill Cornell Medicine and others.).
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