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Meta-Analysis
. 2020 Jul 14;324(2):179-187.
doi: 10.1001/jama.2020.8228.

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  1 , Umberto Benedetto  2 , Stephen Fremes  3 , Karla Ballman  4 , Giuseppe Biondi-Zoccai  5   6 , Art Sedrakyan  4 , Giuseppe Nasso  7 , Jai Raman  8   9 , Brian Buxton  9 , Philip A Hayward  9 , Neil Moat  10 , Peter Collins  10 , Carolyn Webb  10 , Miodrag Peric  11 , Ivana Petrovic  11 , Kyung J Yoo  12 , Irbaz Hameed  1 , Antonino Di Franco  1 , Marco Moscarelli  7 , Giuseppe Speziale  7 , John D Puskas  13 , Leonard N Girardi  1 , David L Hare  14   15 , David P Taggart  16 ; RADIAL Investigators
Affiliations
Meta-Analysis

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 et al. JAMA. .

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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Conflict of interest statement

Conflict of Interest Disclosures: Dr Fremes reported receiving grants from the University of Toronto during the conduct of the study and grants from the Canadian Institutes of Health Research outside the submitted work. Dr Biondi-Zoccai reported consulting for Abbott Vascular and Bayer. Dr Moat reported being an employee of Abbott, Santa Clara. Dr Puskas reported receiving royalties from surgical instruments invented by the author from Scanlan Inc and personal fees from Medtronic outside the submitted work and having a patent to surgical instruments issued and licensed, with royalties paid. Dr Hare reported receiving personal fees from the National Health and Medical Research Council of Australia and grants from the National Heart Foundation of Australia during the conduct of the study and personal fees from Amgen, AstraZeneca, Merck, and Pfizer and nonfinancial support from Lundbeck, Servier, and Vifor outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Cumulative Incidence of Primary and Secondary Composite Outcomes in a Study of the Association of Radial Artery vs Saphenous Vein Graft With Cardiovascular Outcomes Among Patients Undergoing Coronary Artery Bypass Grafting
A, Cumulative incidence of the composite outcome of death, myocardial infarction, or repeat revascularization. Median (interquartile range) observation time: 10.0 (8.5-11.4) years in the radial artery group vs 10.0 (6.1-10.2) years in the saphenous vein group. B, Cumulative incidence of the outcome of death or myocardial infarction. Median (interquartile range) observation time: 10.0 (9.2-12.1) years in the radial artery group vs 10.0 (7.0-10.4) years in the saphenous vein group (patients analyzed according to their randomization group).
Figure 2.
Figure 2.. Forest Plot of the Meta-analytic Estimate for the Composite Primary End Point of Death, Myocardial Infarction, or Revascularization in a Study of the Association of Radial Artery vs Saphenous Vein Graft With Cardiovascular Outcomes Among Patients Undergoing Coronary Artery Bypass Grafting
Figure 3.
Figure 3.. Subgroup Analysis for the Primary Composite Outcome in a Study of the Association of Radial Artery vs Saphenous Vein Graft With Cardiovascular Outcomes Among Patients Undergoing Coronary Artery Bypass Grafting
Subgroup analysis for the primary composite outcome of death, myocardial infarction, or repeat revascularization. Kidney insufficiency was defined as preoperative serum creatinine greater than 1.5 mg/dL. LVEF indicates left ventricular ejection fraction.
See this image and copyright information in PMC

Comment in

References

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