Chronic CCB Therapy Linked to Improved Outcomes After CABG Utilizing the Radial Artery

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Mario F.L. Gaudino, MD, and colleagues evaluated whether calcium-channel blocker therapy influences clinical and angiographic outcomes of radial artery grafts used for coronary bypass surgery.
The following article is part of conference coverage from the 2018 AHA Scientific Sessions in Chicago, Illinois.The Cardiology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in cardiology. Check back for the latest news from AHA 2018.

Calcium-channel blocker therapy (CCB) is associated with significantly improved midterm clinical and angiographic radial artery outcomes, according to data presented at the American Heart Association 2018 Scientific Sessions, held November 10-12, in Chicago, Illinois. The data support the routine use of CCB after coronary bypass surgery (CABG) using the radial artery.

Mario F.L. Gaudino, MD, professor in cardiothoracic surgery and director of translation and clinical research in the Department of Cardiothoracic Surgery at Weill Cornell Medicine in New York, New York, and colleagues sought to evaluate whether CCB influences clinical and angiographic outcomes of radial artery grafts used for CABG.

Patient-level data were combined from 6 angiographic randomized trials that evaluated radial artery graft status at midterm follow-up, including a total of 732 patients. Researchers examined the effects of CCB on the incidence of graft occlusion and major adverse cardiovascular events, including death, myocardial infarction, and repeat revascularization.

Results showed that after a mean follow-up period of 55±20 months, graft failure occurred in 14 patients (5.8%) who received CCB therapy, compared with 27 patients (13.5%) of patients who did not receive CCB therapy (log-rank P <.001). In addition, CCB therapy was significantly associated with better patency rate (hazard ratio [HR], 0.20; 95% CI, 0.08-0.49; P <.001).

The investigators also found that after a mean follow-up of 60±27 months, the number of major adverse cardiovascular events was 56 (11.2%) in patients who received CCB therapy vs 31 (13.5%) among patients who did not receive CCB (log-rank P =.003).

After controlling for confounders, results showed that CCB therapy was independently associated with a significantly lower risk for major adverse cardiovascular events (HR, 0.51; 95% CI, 30-87; P =.01).

The Cardiology Advisor interviewed Mario F.L. Gaudino, MD, cardiothoracic surgeon at Weill Cornell Medicine & NewYork-Presbyterian, regarding the clinical applicability of this research. The question and answer appears below.

The Cardiology Advisor: Based on the results of this study, should CCB therapy be uniformly started immediately after CABG using the radial artery and continued indefinitely? Which subsets of patients may likely benefit the most from immediate CCB initiation?

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Dr Gaudino: This is an observational post-hoc analysis. There is a strong signal in favor of the use of CCB, but further studies are necessary to definitely evaluate their role. In any case, CCBs [continue to be] routinely prescribed by the great majority of surgeons who use the radial artery. All patients may benefit in the same way.

The Cardiology Advisor: Do you expect clinical benefits associated with improved vessel patency to extend to the long-term?

Dr Gaudino: Our mean follow-up was 5 years. It is likely that the benefit will extend to the longer term

The Cardiology Advisor: Is there an added benefit to using CCBs in combination with other medications, including nitrates or beta blockers, to further induce radial patency rates?

Dr Gaudino: Our study was not powered to answer to this question. The benefit of the CCB therapy was evident even when adjusting for other concomitant medications.

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Gaudino M, Benedetto U, Fremes S, et al. Effect of chronic calcium-channel blocker therapy after coronary artery bypass with the radial artery: insights from the RADIAL database. Presented at: the American Heart Association 2018 Scientific Sessions; November 10-12, 2018; Chicago, IL. Abstract 366.