Association of radial artery graft vs saphenous vein graft with long-term cardiovascular outcomes among patients undergoing coronary artery bypass grafting: a systematic review and meta-analysis

Mario Gaudino, Umberto Benedetto, Stephen E. Fremes, Karla Ballman, Giuseppe Biondi-Zoccai, Art Sedrakyan, Giuseppe Nasso, Jai Raman, Brian Buxton, Philip Hayward, Neil Moat, Peter Collins, Carolyn A Webb, Miodrag Peric, Ivana Petrovic, Kyung Jong Yoo, Irbaz Hameed, Antonio Di Franco, Marco Moscarelli, Giuseppe SpezialeJohn D. Puskas, Leonard Girardi, David Hare, David Taggart

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Importance. Observational studies have suggested that the use of radial artery grafts for coronary artery bypass grafting may improve clinical outcomes compared with the use of saphenous vein grafts, but this has not been confirmed in randomized trials.
Objective. To compare clinical outcomes between patients receiving radial artery or saphenous vein grafts for coronary artery bypass grafting at long-term follow-up.
Design, Setting, and Participants. Patient-level pooled analysis comparing radial artery and saphenous vein grafts in adult patients undergoing isolated coronary artery bypass grafting from five countries (Australia, Italy, Serbia, South Korea, and United Kingdom; enrollment years: 1997 to 2009, follow-up completed in 2019).

Intervention. Patients were randomized to receive either radial artery or saphenous vein grafts for coronary artery bypass grafting.Main outcomes and measures. The primary outcome was a composite of death, myocardial infarction or repeat revascularization, and the secondary outcome was a composite of death or myocardial infarction.

Results. 1036 patients (534 radial artery group) were randomized (mean age 66.6 vs 67.1 years, males 70.4% vs 69.9% in the radial artery and the saphenous vein groups, respectively); 942 (90.9%) of the originally randomized patients completed 10 years of follow-up (510 radial artery group). At a median follow-up of 10 years (interquartile range 10-11), the use of the radial artery was associated with a statistically significant reduction in the incidence of the composite outcome of death, myocardial infarction or repeat revascularization (220 vs 237 events; 41 vs 47 events per 1000 patient-years; hazard ratio[HR] 0.73, 95%confidence interval[CI] 0.61-0.88, p<0.001) and of the composite of death or myocardial infarction (188 vs 193 events; 35 vs 38 events per 1000 patient-years; HR 0.77, 95%CI 0.63-0.94, p=0.01).

Conclusions and relevance. In this individual participant data meta-analysis with a median follow up of 10 years, among patients undergoing coronary artery bypass grafting, the use of the radial artery compared with saphenous vein grafts was associated with a lower risk of a composite of cardiovascular outcomes.
Original languageEnglish
Pages (from-to)179-187
Number of pages9
JournalJAMA - Journal of the American Medical Association
DOIs
Publication statusPublished - 14 Jul 2020

Structured keywords

  • Bristol Heart Institute

Keywords

  • Cardiothoracic Surgery
  • Surgery
  • Cardiology
  • Ischemic Heart Disease
  • Acute Coronary Syndromes

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