Radial-artery or saphenous-vein grafts in coronary-artery bypass surgery

Mario Gaudino, Umberto Benedetto, Stephen Fremes, Giuseppe Biondi-Zoccai, Art Sedrakyan, John D. Puskas, Gianni D. Angelini, Brian Buxton, Giacomo Frati, David L. Hare, Philip Hayward, Giuseppe Nasso, Neil Moat, Miodrag Peric, Kyung J. Yoo, Giuseppe Speziale, Leonard N. Girardi, David P. Taggart

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Abstract

BACKGROUND The use of radial-artery grafts for coronary-artery bypass grafting (CABG) may result in better postoperative outcomes than the use of saphenous-vein grafts. However, randomized, controlled trials comparing radial-artery grafts and saphenous-vein grafts have been individually underpowered to detect differences in clinical outcomes. We performed a patient-level combined analysis of randomized, controlled trials to compare radial-artery grafts and saphenous-vein grafts for CABG. METHODS Six trials were identified. The primary outcome was a composite of death, myocardial infarction, or repeat revascularization. The secondary outcome was graft patency on follow-up angiography. Mixed-effects Cox regression models were used to estimate the treatment effect on the outcomes. RESULTS A total of 1036 patients were included in the analysis (534 patients with radialartery grafts and 502 patients with saphenous-vein grafts). After a mean (±SD) follow-up time of 60±30 months, the incidence of adverse cardiac events was significantly lower in association with radial-artery grafts than with saphenousvein grafts (hazard ratio, 0.67; 95% confidence interval [CI], 0.49 to 0.90; P = 0.01). At follow-up angiography (mean follow-up, 50±30 months), the use of radial-artery grafts was also associated with a significantly lower risk of occlusion (hazard ratio, 0.44; 95% CI, 0.28 to 0.70; P<0.001). As compared with the use of saphenous-vein grafts, the use of radial-artery grafts was associated with a nominally lower incidence of myocardial infarction (hazard ratio, 0.72; 95% CI, 0.53 to 0.99; P = 0.04) and a lower incidence of repeat revascularization (hazard ratio, 0.50; 95% CI, 0.40 to 0.63; P<0.001) but not a lower incidence of death from any cause (hazard ratio, 0.90; 95% CI, 0.59 to 1.41; P = 0.68). CONCLUSIONS As compared with the use of saphenous-vein grafts, the use of radial-artery grafts for CABG resulted in a lower rate of adverse cardiac events and a higher rate of patency at 5 years of follow-up. (Funded by Weill Cornell Medicine and others.).

Original languageEnglish
Pages (from-to)2069-2077
Number of pages9
JournalNew England Journal of Medicine
Volume378
Issue number22
DOIs
Publication statusPublished - May 31 2018

ASJC Scopus subject areas

  • Medicine(all)

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    Gaudino, M., Benedetto, U., Fremes, S., Biondi-Zoccai, G., Sedrakyan, A., Puskas, J. D., Angelini, G. D., Buxton, B., Frati, G., Hare, D. L., Hayward, P., Nasso, G., Moat, N., Peric, M., Yoo, K. J., Speziale, G., Girardi, L. N., & Taggart, D. P. (2018). Radial-artery or saphenous-vein grafts in coronary-artery bypass surgery. New England Journal of Medicine, 378(22), 2069-2077. https://doi.org/10.1056/NEJMoa1716026