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Original Investigation
July 14, 2020

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

Author Affiliations
  • 1Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
  • 2Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom
  • 3Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
  • 4Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
  • 5Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
  • 6Mediterranea Cardiocentro, Naples, Italy
  • 7Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
  • 8Austin Hospital, Melbourne, Victoria, Australia
  • 9Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
  • 10NHLI, Imperial College London, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
  • 11Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia
  • 12Yonsei University College of Medicine, Seoul, South Korea
  • 13Department of Cardiovascular Surgery, Mount Sinai St. Luke's, New York, New York
  • 14Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
  • 15Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
  • 16Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
JAMA. 2020;324(2):179-187. doi:10.1001/jama.2020.8228
Key Points

Question  Is the use of the radial artery instead of the saphenous vein for coronary artery bypass surgery associated with a lower risk of adverse cardiac events in the long term?

Findings  In this individual participant data meta-analysis from 5 randomized clinical trials that included 1036 patients undergoing coronary artery bypass grafting, randomization to receive radial artery compared with saphenous vein graft was associated with an incidence of a composite of death, myocardial infarction, or repeat revascularization of 41 vs 47 events per 1000 person-years after a median follow-up of 10 years, a difference that was statistically significant.

Meaning  Over 10 years of follow-up, radial artery graft compared with saphenous vein graft was associated with a lower risk of a composite of cardiovascular outcomes.

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 vs saphenous vein grafts for coronary artery bypass grafting after long-term follow-up.

Design, Setting, and Participants  Patient-level pooled analysis comparing radial artery vs saphenous vein graft in adult patients undergoing isolated coronary artery bypass grafting from 5 countries (Australia, Italy, Serbia, South Korea, and the United Kingdom), with enrollment from 1997 to 2009 and follow-up completed in 2019.

Interventions  Patients were randomized to undergo either radial artery (n = 534) or saphenous vein (n = 502) 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  A total of 1036 patients were randomized (mean age, 66.6 years in the radial artery group vs 67.1 years in the saphenous vein group; 376 [70.4%] men in the radial artery group vs 351 [69.9%] in the saphenous vein group); 942 (90.9%) of the originally randomized patients completed 10 years of follow-up (510 in the radial artery group). At a median (interquartile range) follow-up of 10 (10-11) years, the use of the radial artery, compared with the saphenous vein, in coronary artery bypass grafting was associated with a statistically significant reduction in the incidence of the composite outcome of death, myocardial infarction, or repeat revascularization (220 vs 237 total events; 41 vs 47 events per 1000 patient-years; hazard ratio, 0.73 [95% CI, 0.61-0.88]; P < .001) and of the composite of death or myocardial infarction (188 vs 193 total events; 35 vs 38 events per 1000 patient-years; hazard ratio, 0.77 [95% CI, 0.63-0.94]; P = .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 the saphenous vein was associated with a lower risk of a composite of cardiovascular outcomes.

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