TY - JOUR
T1 - Long-term clinical outcome and graft patency of radial artery and saphenous vein grafts in multiple arterial revascularization
AU - RADIAL Investigators
AU - Ruttmann, Elfriede
AU - Dietl, Marion
AU - Feuchtner, Gudrun M.
AU - Metzler, Bernhard
AU - Bonaros, Nikolaos
AU - Taggart, David P.
AU - Gaudino, Mario
AU - Ulmer, Hanno
AU - Benedetto, Umberto
AU - Buxton, Brian
AU - Di Franco, Antonio
AU - Fremes, Stephen
AU - Girardi, Leonard N.
AU - Goldman, Steven
AU - Habib, Robert
AU - Holman, William L.
AU - Puskas, John D.
AU - Ruttmann-Ulmer, Elfriede
AU - Schwann, Thomas A.
AU - Tatoulis, James
AU - Tranbaugh, Robert
AU - Speciale, Giuseppe
AU - Nasso, Giuseppe
AU - Moat, Neil
AU - Hayward, Philip
AU - Hare, David L.
AU - Mao, Jialin
AU - Peric, Miodrag
AU - Petrovic, Ivana
AU - Yoo, Kyung Jong
N1 - Publisher Copyright:
© 2018 The American Association for Thoracic Surgery
PY - 2019/8
Y1 - 2019/8
N2 - Objective: The long-term benefits of multiple arterial revascularization (MAR) in coronary artery bypass grafting remain uncertain. The aim of this study was to investigate the clinical outcome, graft patency, and need for subsequent target revascularization of radial artery (RA) versus saphenous vein graft in patients undergoing MAR in both patient- and graft-specific analyses. Methods: Between 2001 and 2016, we followed 1654 patients over a median of 7.4 years in a prospective, longitudinal study. Major adverse cardiac and cerebrovascular events, graft patency, and need for revascularization were assessed through clinical manifestation, coronary angiography, or coronary computed tomography and analyzed with propensity score–adjusted Cox regression, general estimating equation, and competing risk models. Results: Bilateral internal thoracic artery (BITA) grafting was performed in 910 patients (55.0%), and 744 patients (45.0%) received a left internal thoracic artery graft together with at least 1 RA graft. Patients receiving BITA, of whom 187 received an additional RA, showed improved survival (hazard ratio, 0.57; 95% confidence interval [CI], 0.38-0.86; P = .009), major adverse cardiac and cerebrovascular event–free survival (hazard ratio, 0.33; 95% CI, 0.23-0.46; P < .001), and lower need for repeat revascularization (subhzhard ratio, 0.59; 95% CI, 0.39-0.90; P = .015). In a subgroup of 512 patients, comparing 419 RA with 487 saphenous vein grafts, RA grafting showed a lower risk for graft occlusion (odds ratio, 0.59; 95% CI, 0.47-0.73; P < .001) and target revascularization (subhazard ratio, 0.58; 95% CI, 0.43-0.78; P < .001). Conclusions: MAR with BITA and RA grafting revealed to be the recommended strategy in coronary artery bypass grafting to achieve long-term beneficial results. The use of saphenous vein graft showed less favorable outcomes regarding patency and the need for target-vessel revascularization.
AB - Objective: The long-term benefits of multiple arterial revascularization (MAR) in coronary artery bypass grafting remain uncertain. The aim of this study was to investigate the clinical outcome, graft patency, and need for subsequent target revascularization of radial artery (RA) versus saphenous vein graft in patients undergoing MAR in both patient- and graft-specific analyses. Methods: Between 2001 and 2016, we followed 1654 patients over a median of 7.4 years in a prospective, longitudinal study. Major adverse cardiac and cerebrovascular events, graft patency, and need for revascularization were assessed through clinical manifestation, coronary angiography, or coronary computed tomography and analyzed with propensity score–adjusted Cox regression, general estimating equation, and competing risk models. Results: Bilateral internal thoracic artery (BITA) grafting was performed in 910 patients (55.0%), and 744 patients (45.0%) received a left internal thoracic artery graft together with at least 1 RA graft. Patients receiving BITA, of whom 187 received an additional RA, showed improved survival (hazard ratio, 0.57; 95% confidence interval [CI], 0.38-0.86; P = .009), major adverse cardiac and cerebrovascular event–free survival (hazard ratio, 0.33; 95% CI, 0.23-0.46; P < .001), and lower need for repeat revascularization (subhzhard ratio, 0.59; 95% CI, 0.39-0.90; P = .015). In a subgroup of 512 patients, comparing 419 RA with 487 saphenous vein grafts, RA grafting showed a lower risk for graft occlusion (odds ratio, 0.59; 95% CI, 0.47-0.73; P < .001) and target revascularization (subhazard ratio, 0.58; 95% CI, 0.43-0.78; P < .001). Conclusions: MAR with BITA and RA grafting revealed to be the recommended strategy in coronary artery bypass grafting to achieve long-term beneficial results. The use of saphenous vein graft showed less favorable outcomes regarding patency and the need for target-vessel revascularization.
KW - coronary artery bypass grafting (CABG)
KW - graft failure
KW - multiple arterial revascularization (MAR)
KW - radial artery (RA)
KW - saphenous vein graft (SVG)
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U2 - 10.1016/j.jtcvs.2018.10.135
DO - 10.1016/j.jtcvs.2018.10.135
M3 - Article
C2 - 30551960
AN - SCOPUS:85058038064
SN - 0022-5223
VL - 158
SP - 442
EP - 450
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 2
ER -