Effect of Calcium-Channel Blocker Therapy on Radial Artery Grafts After Coronary Bypass Surgery

RADIAL Investigators

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Few studies have evaluated the effect of chronic calcium-channel blocker therapy (CCB) on the angiographic and clinical outcome of radial artery (RA) grafts used for coronary bypass surgery. Objectives: The purpose of this study was to evaluate if CCB influences midterm clinical and angiographic outcomes of RA grafts. Methods: Patient-level data of 6 angiographic randomized trials evaluating RA graft status at midterm follow-up were joined in this observational analysis. Cox regression and propensity score methods were used to evaluate the effect of CCB on the incidence of a composite of major adverse cardiac events (MACE) (death, myocardial infarction, and repeat revascularization) and graft occlusion. Results: The study population included 732 patients (502 on CCB). The median clinical follow-up was 60 months. The cumulative incidence of MACE at 36, 72, and 108 months was 3.7% vs. 9.3%, 13.4% vs. 17.6%, and 16.8% vs. 20.5% in the CCB and no CCB groups, respectively (log-rank p = 0.003). Protocol-driven angiographic follow-up was available in 243 patients in the CCB group and 200 in the no CCB group. The median angiographic follow-up was 55 months. The cumulative incidence of RA occlusion at 36, 72, and 108 months was 0.9% vs. 8.6%, 9.6% vs. 21.4%, and 14.3% vs. 38.9% in the CCB and no CCB groups, respectively (log-rank p < 0.001). After controlling for known confounding, CCB therapy was found to be consistently associated with a significantly lower risk of MACE (multivariate Cox hazard ratio: 0.52; 95% confidence interval: 0.31 to 0.89; p = 0.02) and RA graft occlusion (multivariate Cox hazard ratio: 0.20; 95% confidence interval: 0.08 to 0.49; p < 0.001). Conclusions: In patients with RA grafts CCB is associated with significantly better midterm clinical and angiographic RA outcomes.

Original languageEnglish (US)
Pages (from-to)2299-2306
Number of pages8
JournalJournal of the American College of Cardiology
Volume73
Issue number18
DOIs
StatePublished - May 14 2019

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Radial Artery
Calcium Channel Blockers
Transplants
Group Psychotherapy
Therapeutics
Incidence
Confidence Intervals
Propensity Score
Myocardial Infarction

Keywords

  • CABG
  • calcium-channel blocker
  • radial artery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effect of Calcium-Channel Blocker Therapy on Radial Artery Grafts After Coronary Bypass Surgery. / RADIAL Investigators.

In: Journal of the American College of Cardiology, Vol. 73, No. 18, 14.05.2019, p. 2299-2306.

Research output: Contribution to journalArticle

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title = "Effect of Calcium-Channel Blocker Therapy on Radial Artery Grafts After Coronary Bypass Surgery",
abstract = "Background: Few studies have evaluated the effect of chronic calcium-channel blocker therapy (CCB) on the angiographic and clinical outcome of radial artery (RA) grafts used for coronary bypass surgery. Objectives: The purpose of this study was to evaluate if CCB influences midterm clinical and angiographic outcomes of RA grafts. Methods: Patient-level data of 6 angiographic randomized trials evaluating RA graft status at midterm follow-up were joined in this observational analysis. Cox regression and propensity score methods were used to evaluate the effect of CCB on the incidence of a composite of major adverse cardiac events (MACE) (death, myocardial infarction, and repeat revascularization) and graft occlusion. Results: The study population included 732 patients (502 on CCB). The median clinical follow-up was 60 months. The cumulative incidence of MACE at 36, 72, and 108 months was 3.7{\%} vs. 9.3{\%}, 13.4{\%} vs. 17.6{\%}, and 16.8{\%} vs. 20.5{\%} in the CCB and no CCB groups, respectively (log-rank p = 0.003). Protocol-driven angiographic follow-up was available in 243 patients in the CCB group and 200 in the no CCB group. The median angiographic follow-up was 55 months. The cumulative incidence of RA occlusion at 36, 72, and 108 months was 0.9{\%} vs. 8.6{\%}, 9.6{\%} vs. 21.4{\%}, and 14.3{\%} vs. 38.9{\%} in the CCB and no CCB groups, respectively (log-rank p < 0.001). After controlling for known confounding, CCB therapy was found to be consistently associated with a significantly lower risk of MACE (multivariate Cox hazard ratio: 0.52; 95{\%} confidence interval: 0.31 to 0.89; p = 0.02) and RA graft occlusion (multivariate Cox hazard ratio: 0.20; 95{\%} confidence interval: 0.08 to 0.49; p < 0.001). Conclusions: In patients with RA grafts CCB is associated with significantly better midterm clinical and angiographic RA outcomes.",
keywords = "CABG, calcium-channel blocker, radial artery",
author = "{RADIAL Investigators} and Mario Gaudino and Umberto Benedetto and Fremes, {Stephen E.} and Hare, {David L.} and Philip Hayward and Neil Moat and Marco Moscarelli and {Di Franco}, Antonino and Giuseppe Nasso and Miodrag Peric and Ivana Petrovic and Puskas, {John D.} and Giuseppe Speziale and Yoo, {Kyung Jong} and Girardi, {Leonard N.} and Taggart, {David P.} and Taggart, {David P.} and Brian Buxton and Stephen Fremes and Girardi, {Leonard N.} and Steven Goldman and Hare, {David L.} and Holman, {William L.} and Robert Habib and Jialin Mao and Puskas, {John D.} and Elfriede Ruttmann-Ulmer and Schwann, {Thomas A.} and James Tatoulis and Robert Tranbaugh",
year = "2019",
month = "5",
day = "14",
doi = "10.1016/j.jacc.2019.02.054",
language = "English (US)",
volume = "73",
pages = "2299--2306",
journal = "Journal of the American College of Cardiology",
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TY - JOUR

T1 - Effect of Calcium-Channel Blocker Therapy on Radial Artery Grafts After Coronary Bypass Surgery

AU - RADIAL Investigators

AU - Gaudino, Mario

AU - Benedetto, Umberto

AU - Fremes, Stephen E.

AU - Hare, David L.

AU - Hayward, Philip

AU - Moat, Neil

AU - Moscarelli, Marco

AU - Di Franco, Antonino

AU - Nasso, Giuseppe

AU - Peric, Miodrag

AU - Petrovic, Ivana

AU - Puskas, John D.

AU - Speziale, Giuseppe

AU - Yoo, Kyung Jong

AU - Girardi, Leonard N.

AU - Taggart, David P.

AU - Taggart, David P.

AU - Buxton, Brian

AU - Fremes, Stephen

AU - Girardi, Leonard N.

AU - Goldman, Steven

AU - Hare, David L.

AU - Holman, William L.

AU - Habib, Robert

AU - Mao, Jialin

AU - Puskas, John D.

AU - Ruttmann-Ulmer, Elfriede

AU - Schwann, Thomas A.

AU - Tatoulis, James

AU - Tranbaugh, Robert

PY - 2019/5/14

Y1 - 2019/5/14

N2 - Background: Few studies have evaluated the effect of chronic calcium-channel blocker therapy (CCB) on the angiographic and clinical outcome of radial artery (RA) grafts used for coronary bypass surgery. Objectives: The purpose of this study was to evaluate if CCB influences midterm clinical and angiographic outcomes of RA grafts. Methods: Patient-level data of 6 angiographic randomized trials evaluating RA graft status at midterm follow-up were joined in this observational analysis. Cox regression and propensity score methods were used to evaluate the effect of CCB on the incidence of a composite of major adverse cardiac events (MACE) (death, myocardial infarction, and repeat revascularization) and graft occlusion. Results: The study population included 732 patients (502 on CCB). The median clinical follow-up was 60 months. The cumulative incidence of MACE at 36, 72, and 108 months was 3.7% vs. 9.3%, 13.4% vs. 17.6%, and 16.8% vs. 20.5% in the CCB and no CCB groups, respectively (log-rank p = 0.003). Protocol-driven angiographic follow-up was available in 243 patients in the CCB group and 200 in the no CCB group. The median angiographic follow-up was 55 months. The cumulative incidence of RA occlusion at 36, 72, and 108 months was 0.9% vs. 8.6%, 9.6% vs. 21.4%, and 14.3% vs. 38.9% in the CCB and no CCB groups, respectively (log-rank p < 0.001). After controlling for known confounding, CCB therapy was found to be consistently associated with a significantly lower risk of MACE (multivariate Cox hazard ratio: 0.52; 95% confidence interval: 0.31 to 0.89; p = 0.02) and RA graft occlusion (multivariate Cox hazard ratio: 0.20; 95% confidence interval: 0.08 to 0.49; p < 0.001). Conclusions: In patients with RA grafts CCB is associated with significantly better midterm clinical and angiographic RA outcomes.

AB - Background: Few studies have evaluated the effect of chronic calcium-channel blocker therapy (CCB) on the angiographic and clinical outcome of radial artery (RA) grafts used for coronary bypass surgery. Objectives: The purpose of this study was to evaluate if CCB influences midterm clinical and angiographic outcomes of RA grafts. Methods: Patient-level data of 6 angiographic randomized trials evaluating RA graft status at midterm follow-up were joined in this observational analysis. Cox regression and propensity score methods were used to evaluate the effect of CCB on the incidence of a composite of major adverse cardiac events (MACE) (death, myocardial infarction, and repeat revascularization) and graft occlusion. Results: The study population included 732 patients (502 on CCB). The median clinical follow-up was 60 months. The cumulative incidence of MACE at 36, 72, and 108 months was 3.7% vs. 9.3%, 13.4% vs. 17.6%, and 16.8% vs. 20.5% in the CCB and no CCB groups, respectively (log-rank p = 0.003). Protocol-driven angiographic follow-up was available in 243 patients in the CCB group and 200 in the no CCB group. The median angiographic follow-up was 55 months. The cumulative incidence of RA occlusion at 36, 72, and 108 months was 0.9% vs. 8.6%, 9.6% vs. 21.4%, and 14.3% vs. 38.9% in the CCB and no CCB groups, respectively (log-rank p < 0.001). After controlling for known confounding, CCB therapy was found to be consistently associated with a significantly lower risk of MACE (multivariate Cox hazard ratio: 0.52; 95% confidence interval: 0.31 to 0.89; p = 0.02) and RA graft occlusion (multivariate Cox hazard ratio: 0.20; 95% confidence interval: 0.08 to 0.49; p < 0.001). Conclusions: In patients with RA grafts CCB is associated with significantly better midterm clinical and angiographic RA outcomes.

KW - CABG

KW - calcium-channel blocker

KW - radial artery

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DO - 10.1016/j.jacc.2019.02.054

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JO - Journal of the American College of Cardiology

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