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Predictors of Radial Artery Use in Coronary Bypass Grafting: A Multi-institutional Cohort Study
Sean W W Noona1, Steven D Young1, Andrew M Young1
1Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
Insights
Radial artery graft utilization in coronary artery bypass grafting (CABG) increased significantly from 2017 to 2022. However, radial artery (RA) use remains limited, favoring younger, healthier patients, suggesting careful consideration of patient factors and long-term benefits.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Surgical Outcomes
Background:
- Coronary artery bypass grafting (CABG) is a primary revascularization strategy.
- Radial artery (RA) utilization as a graft in CABG is increasingly explored.
- Understanding predictors of RA use is crucial for optimizing CABG procedures.
Purpose of the Study:
- To investigate trends in radial artery utilization for isolated CABG.
- To identify clinical and angiographic predictors associated with radial graft use.
- To analyze the impact of patient demographics and risk factors on RA selection.
Main Methods:
- Analysis of a large cohort (17,352 patients) undergoing isolated CABG between 2017 and 2022.
- Data linkage between the Society of Thoracic Surgeons Adult Cardiac Surgery Database and the National Cardiovascular Data Registry CathPCI registry.
- Multivariable logistic regression modeling to determine predictors of radial artery graft use.
Main Results:
- Radial artery graft (RAG) use increased from 3.34% in 2017 to 14.24% in 2022.
- RAG recipients were younger, had lower predicted risk of morbidity/mortality, and less heart failure.
- Predictors of RA use included higher ejection fraction, male sex, and increasing surgery year; severe CKD and older age decreased likelihood.
Conclusions:
- Radial artery use in CABG is still limited and primarily benefits younger, healthier individuals.
- Surgeons appear to consider clinical status and potential long-term advantages when selecting radial grafts.
- Further understanding of RA graft predictors may improve CABG outcomes across diverse patient populations.
Introduction:
To explore trends and analyze clinical and angiographic predictors of radial utilization in patients undergoing isolated coronary artery bypass grafting (CABG).
Methods:
We analyzed data from 17,352 patients undergoing isolated CABG (January 1, 2017, to December 31, 2022) in a regional Society of Thoracic Surgeons Adult Cardiac Surgery Database linked with the National Cardiovascular Data Registry CathPCI registry. Multivariable logistic regression assessed predictors of radial artery (RA) use.
Results:
Radial artery grafts (RAGs) were used in 1745 patients (10.0%). Utilization increased from 3.34% (2017) to 14.24% (2022) (P < 0.001). Patients receiving RAGs were younger (60 [53-67] versus 67 [60-73] y, P < 0.001), had lower predicted risk of morbidity or mortality (6% versus 9%, P < 0.001), and lower incidence of heart failure (25% versus 32%, P < 0.001). Predictors of RA use included higher preoperative ejection fraction (odds ratio [OR] 1.18 [1.10-1.27], P < 0.001), male sex (OR 1.72 [1.44-2.05], P < 0.001), and increasing surgery year (OR 1.38 [1.33-1.44], P < 0.001). Conversely, severe chronic kidney disease (OR 0.30 [0.18-0.49], P < 0.001), older age (OR 0.56 [0.52-0.60], P < 0.001), and higher predicted risk of morbidity or mortality (OR 0.79 [0.71-0.89], P < 0.001) decreased likelihood of receiving a RAG. Critical lesion stenosis (≥90%) did not predict RA use (OR 1.06 [0.78-1.44], P = 0.70).
Conclusions:
RA use in CABG remains limited, predominantly in younger, healthier patients. These findings suggest surgeons likely consider clinical and potential long-term benefits in choosing radial grafting. Understanding relative predictors of radial grafting could enhance CABG outcomes across patient demographics.
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