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Published on: March 27, 2018
Effect of Calcium-Channel Blocker Therapy on Radial Artery Grafts After Coronary Bypass Surgery
Mario Gaudino1, Umberto Benedetto2, Stephen E Fremes3
1Department of Cardiothoracic Surgery, Cornell Medicine, New York, New York.
Insights
Calcium-channel blocker therapy (CCB) significantly improves outcomes for radial artery (RA) grafts in coronary bypass surgery. CCB use is linked to lower rates of major adverse cardiac events and graft occlusion in midterm follow-up.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Clinical Outcomes Research
Background:
- Limited research exists on the long-term impact of calcium-channel blocker therapy (CCB) on radial artery (RA) grafts in coronary artery bypass grafting (CABG).
- Understanding CCB's effect on RA graft patency and patient outcomes is crucial for optimizing surgical strategies.
Purpose of the Study:
- To investigate whether CCB therapy influences midterm clinical and angiographic outcomes of RA grafts.
- To assess the association between CCB use and major adverse cardiac events (MACE) and radial artery graft occlusion.
Main Methods:
- A pooled analysis of patient-level data from 6 randomized trials involving RA grafts was conducted.
- Cox regression and propensity score methods were employed to evaluate the impact of CCB on MACE and graft occlusion.
- Clinical and angiographic follow-up data up to 108 months were analyzed.
Main Results:
- Patients on CCB (n=502) exhibited significantly lower cumulative incidences of MACE compared to those not on CCB (n=230) at 108 months (16.8% vs. 20.5%, p=0.003).
- Radial artery graft occlusion rates were substantially reduced in the CCB group (14.3% vs. 38.9% at 108 months, p<0.001).
- Multivariate analysis confirmed CCB therapy was associated with a 48% lower risk of MACE (HR 0.52; p=0.02) and an 80% lower risk of graft occlusion (HR 0.20; p<0.001).
Conclusions:
- Calcium-channel blocker therapy is associated with significantly improved midterm clinical outcomes in patients receiving radial artery grafts.
- CCB use demonstrates a protective effect against radial artery graft occlusion, enhancing long-term graft patency.
- These findings suggest CCB therapy should be considered in the management of patients with radial artery grafts post-CABG.
Background:
Few studies have evaluated the effect of chronic calcium-channel blocker therapy (CCB) on the angiographic and clinical outcome of radial artery (RA) grafts used for coronary bypass surgery.
Objectives:
The purpose of this study was to evaluate if CCB influences midterm clinical and angiographic outcomes of RA grafts.
Methods:
Patient-level data of 6 angiographic randomized trials evaluating RA graft status at midterm follow-up were joined in this observational analysis. Cox regression and propensity score methods were used to evaluate the effect of CCB on the incidence of a composite of major adverse cardiac events (MACE) (death, myocardial infarction, and repeat revascularization) and graft occlusion.
Results:
The study population included 732 patients (502 on CCB). The median clinical follow-up was 60 months. The cumulative incidence of MACE at 36, 72, and 108 months was 3.7% vs. 9.3%, 13.4% vs. 17.6%, and 16.8% vs. 20.5% in the CCB and no CCB groups, respectively (log-rank p = 0.003). Protocol-driven angiographic follow-up was available in 243 patients in the CCB group and 200 in the no CCB group. The median angiographic follow-up was 55 months. The cumulative incidence of RA occlusion at 36, 72, and 108 months was 0.9% vs. 8.6%, 9.6% vs. 21.4%, and 14.3% vs. 38.9% in the CCB and no CCB groups, respectively (log-rank p < 0.001). After controlling for known confounding, CCB therapy was found to be consistently associated with a significantly lower risk of MACE (multivariate Cox hazard ratio: 0.52; 95% confidence interval: 0.31 to 0.89; p = 0.02) and RA graft occlusion (multivariate Cox hazard ratio: 0.20; 95% confidence interval: 0.08 to 0.49; p < 0.001).
Conclusions:
In patients with RA grafts CCB is associated with significantly better midterm clinical and angiographic RA outcomes.
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