Radial artery versus saphenous vein versus right internal thoracic artery for coronary artery bypass grafting

Area of Science:

• Cardiovascular Surgery
• Vascular Grafting
• Clinical Outcomes Research

Background:

• Graft selection is crucial for long-term success in coronary artery bypass grafting (CABG).
• The radial artery (RA), right internal thoracic artery (RITA), and saphenous vein graft (SVG) are commonly used to supplement the left internal thoracic artery (LITA).
• Comparative long-term outcome data for these complementary grafts are essential for surgical decision-making.

Purpose of the Study:

• To compare the long-term clinical outcomes of using RA, RITA, or SVG as complementary grafts in CABG.
• To evaluate differences in all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) among the graft types.

Main Methods:

• Pooled analysis of individual patient data from 4 large contemporary CABG trials.
• Propensity score matching and Cox regression analysis were employed to control for confounding factors and treatment selection bias.
• Primary outcome: all-cause mortality. Secondary outcome: composite of MACCE (mortality, myocardial infarction, stroke).

Main Results:

• The study included 10,256 patients; 1,776 were analyzed after propensity score matching.
• Radial artery (RA) grafting was associated with significantly lower all-cause mortality compared to both SVG and RITA.
• RA also demonstrated a significantly lower rate of MACCE compared to SVG and RITA, with a mean follow-up of approximately 7.8 years.

Conclusions:

• In this large pooled analysis, the radial artery (RA) is associated with superior long-term clinical outcomes in CABG compared to SVG and RITA.
• The findings support the use of RA as a preferred complementary graft in CABG surgery.
• RA offers significant benefits in reducing mortality and MACCE, underscoring its role in improving patient prognosis.