Outcomes following revascularization with radial artery bypass grafts: Insights from the PREVENT-IV trial
Oliver K Jawitz1, Morgan L Cox1, David Ranney2
1Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
Insights
Radial artery grafts in coronary artery bypass grafting (CABG) show comparable failure rates to vein grafts but higher than mammary artery grafts. These grafts did not increase adverse clinical outcomes, suggesting they are a viable alternative for specific severe blockages.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafts
- Coronary Artery Bypass Grafting
Background:
- The optimal use of radial artery grafts in coronary artery bypass grafting (CABG) is not fully established.
- Uncertainty exists regarding the long-term efficacy and safety of radial artery grafts compared to traditional conduits.
Purpose of the Study:
- To evaluate the angiographic and clinical outcomes of patients undergoing CABG who received radial artery grafts.
- To compare the performance of radial artery grafts against other graft types in a clinical trial setting.
Main Methods:
- Analysis of the angiographic cohort from the PREVENT-IV trial, stratifying patients based on radial artery graft use.
- Comparison of baseline characteristics, 1-year angiographic results, and 5-year clinical outcomes between radial artery graft recipients and controls.
Main Results:
- Radial artery grafts had a 23.0% failure rate, similar to vein grafts (25.2%) and higher than left internal mammary artery grafts (8.3%).
- No significant difference in the composite outcome of death, myocardial infarction, or repeat revascularization was observed between cohorts.
- Higher failure rates for radial grafts were noted when bypassing moderately stenotic lesions (<75%) compared to severely stenotic lesions (≥75%).
Conclusions:
- Radial artery grafts demonstrate early failure rates comparable to saphenous vein grafts but higher than left internal mammary artery grafts.
- The use of radial artery grafts was not associated with an increased risk of major adverse cardiovascular events.
- Radial artery grafts are a suitable alternative to saphenous vein grafts, particularly for bypassing severely stenotic coronary arteries.
Background:
The optimal role of radial artery grafts in coronary artery bypass grafting (CABG) remains uncertain. The purpose of this study was to examine angiographic and clinical outcomes following CABG among patients who received a radial artery graft.
Methods:
Patients in the angiographic cohort of the PREVENT-IV trial were stratified based upon having received a radial artery graft or not during CABG. Baseline characteristics and 1-year angiographic and 5-year clinical outcomes were compared between patients.
Results:
Of 1,923 patients in the angiographic cohort of PREVENT-IV, 117 received a radial artery graft. These patients had longer surgical procedures (median 253 vs 228 minutes, P < .001) and had a greater number of grafts placed (P < .0001). Radial artery grafts had a graft-level failure rate of 23.0%, which was similar to vein grafts (25.2%) and higher than left internal mammary artery grafts (8.3%). The hazard of the composite clinical outcome of death, myocardial infarction, or repeat revascularization was similar for both cohorts (adjusted hazard ratio 0.896, 95% CI 0.609-1.319, P = .58). Radial graft failure rates were higher when used to bypass moderately stenotic lesions (<75% stenosis, 37% failure) compared with severely stenotic lesions (≥75% stenosis, 15% failure).
Conclusions:
Radial artery grafts had early failure rates comparable to saphenous vein and higher than left internal mammary artery grafts. Use of a radial graft was not associated with a different rate of death, myocardial infarction, or postoperative revascularization. Despite the significant potential for residual confounding associated with post hoc observational analyses of clinical trial data, these findings suggest that when clinical circumstances permit, the radial artery is an acceptable alternative to saphenous vein and should be used to bypass severely stenotic target vessels.
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