Radial Artery vs Saphenous Vein Use in CABG: Examining Long-Term Outcomes

CABG vs PCI for T2DM and CAD
CABG vs PCI for T2DM and CAD
Use of radial artery vs saphenous vein for coronary artery bypass grafting was found to be associated with a reduced long-term risk for a composite of cardiovascular outcomes.

Use of radial artery vs saphenous vein for coronary artery bypass grafting (CABG) was found to be associated with a reduced long-term risk for a composite of cardiovascular outcomes, according to a systematic review and meta-analysis published in JAMA.

In this review, the data of 1036 patients undergoing CABG enrolled in 5 randomized clinical trials were examined. Of these participants, 90.9% were included in the follow-up (510 in the radial artery group) which occurred 10 years after intervention. Of these patients, 534 (mean age, 66.6 years; 70.4% men) underwent radial artery grafting, and 502 patients (mean age, 67.1%; 69.9% men) underwent saphenous vein grafting. The participants were enrolled in 5 countries between 1997 and 2009, and follow-up was completed in 2019. The primary outcome measure was a composite of death, myocardial infarction, or repeat revascularization. The secondary outcome was a composite of death or myocardial infarction.

The use of radial artery vs saphenous vein grafting was associated with a reduction in the primary outcome measure (220 vs 237 total events, respectively; 41 vs 47 events per 1000 patient-years, respectively; hazard ratio, 0.73; 95% CI, 0.61-0.88; P <.001) and in the secondary outcome measure (188 vs 193 total events, respectively; 35 vs 38 events per 1000 patient-years, respectively; hazard ratio, 0.77; 95% CI, 0.63-0.94; P =.01).

Study limitations include a lack of standardized definitions of outcomes, of a central adjudicating committee, and of data source verification. In addition, the surgical procedures were conducted more than 10 years ago and some protocols may no longer be a part of current practice.

“In this individual participant data meta-analysis from 5 randomized clinical trials that included 1036 patients undergoing coronary artery bypass grafting, randomization to receive radial artery compared with saphenous vein graft was associated with an incidence of a composite of death, myocardial infarction, or repeat revascularization of 41 vs 47 events per 1000 person-years after a median follow-up of 10 years, a difference that was statistically significant,” the researchers stated.

Disclosures: Some of the study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.

Reference

Gaudino M, Benedetto U, Fremes S, et al. 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. JAMA. 2020;324:179-187.