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