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Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery

Authors
 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 
Citation
 NEW ENGLAND JOURNAL OF MEDICINE, Vol.378(22) : 2069-2077, 2018 
Journal Title
 NEW ENGLAND JOURNAL OF MEDICINE 
ISSN
 0028-4793 
Issue Date
2018
MeSH
Aged ; Coronary Angiography ; Coronary Artery Bypass/adverse effects/*methods ; Coronary Artery Disease/mortality/*surgery ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/epidemiology ; Postoperative Complications/epidemiology ; Proportional Hazards Models ; Radial Artery/*transplantation ; Randomized Controlled Trials as Topic ; Reoperation/statistics & numerical data ; Saphenous Vein/*transplantation ; Treatment Failure ; *Vascular Patency
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 radial-artery 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 saphenous-vein 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.).
Full Text
https://www.nejm.org/doi/10.1056/NEJMoa1716026
DOI
10.1056/NEJMoa1716026
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/162524
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