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Resultados a largo plazo de los ensayos RAPCO
Brian F Buxton1,2, Philip A Hayward2, Jai Raman1,2
1Department of Cardiac Surgery, Austin Hospital, Melbourne, Australia (B.F.B., J.R., S.C.M., S.S., G.M.).
Circulation
|October 5, 2020
Resumen
La arteria radial (RA) muestra una permeabilidad superior a largo plazo en comparación con los injertos de la arteria torácica interna derecha (RITA) y la vena safena (SV) en la cirugía de derivación coronaria. Esta mejora de la permeabilidad también puede correlacionarse con mejores tasas de supervivencia de los pacientes.
Área de la Ciencia:
- Cirugía cardiovascular
- Injerto vascular
- Ensayos clínicos
Sus antecedentes:
- El bypass de la arteria coronaria (CABG) comúnmente utiliza injertos de la arteria torácica interna.
- La selección óptima de un segundo conducto para el CABG sigue siendo objeto de debate.
- Se iniciaron los ensayos de patencia de la arteria radial y resultados clínicos (RAPCO) para abordar esta controversia.
Objetivo del estudio:
- Para comparar la permeabilidad a largo plazo del injerto de la arteria radial (RA) frente a la arteria torácica interna derecha (RITA).
- Para comparar la permeabilidad del injerto a largo plazo de la arteria radial (AR) frente a la vena safena (SV).
Principales métodos:
- RAPCO-RITA: 394 pacientes fueron asignados al azar al injerto de AR o al injerto libre de RITA.
- RAPCO-SV: 225 pacientes fueron asignados al azar al injerto de AR o SV.
- Resultado primario: insuficiencia del injerto a 10 años; resultado secundario: supervivencia del paciente a 10 años.
Principales resultados:
- La patencia de la AR a 10 años (89%) fue significativamente mayor que la RITA libre (80%) y la SV (71%).
- RA demostró un menor riesgo de insuficiencia del injerto en comparación con RITA (HR 0.45) y SV (HR 0.40).
- La supervivencia a 10 años de los pacientes fue mayor en el grupo de AR en comparación con RITA (90, 9% frente a 83, 7%) y SV (72, 6% frente a 65, 2%).
Conclusiones:
- La arteria radial ofrece tasas de permeabilidad a 10 años significativamente más altas que los injertos RITA y SV libres.
- Estos hallazgos apoyan el uso de la arteria radial como un segundo conducto favorable en CABG.
- La mejora de la permeabilidad del injerto con AR puede traducirse en una mayor supervivencia a largo plazo del paciente.
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