Long-term clinical outcome and graft patency of radial artery and saphenous vein grafts in multiple arterial revascularization

RADIAL Investigators

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)442-450
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume158
Issue number2
DOIs
StatePublished - Aug 2019

Fingerprint

Radial Artery
Saphenous Vein
Transplants
Mammary Arteries
Confidence Intervals
Coronary Artery Bypass
Survival
Coronary Angiography
Longitudinal Studies
Odds Ratio
Tomography
Prospective Studies

Keywords

  • coronary artery bypass grafting (CABG)
  • graft failure
  • multiple arterial revascularization (MAR)
  • radial artery (RA)
  • saphenous vein graft (SVG)

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Long-term clinical outcome and graft patency of radial artery and saphenous vein grafts in multiple arterial revascularization. / RADIAL Investigators.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 158, No. 2, 08.2019, p. 442-450.

Research output: Contribution to journalArticle

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title = "Long-term clinical outcome and graft patency of radial artery and saphenous vein grafts in multiple arterial revascularization",
abstract = "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.",
keywords = "coronary artery bypass grafting (CABG), graft failure, multiple arterial revascularization (MAR), radial artery (RA), saphenous vein graft (SVG)",
author = "{RADIAL Investigators} and Elfriede Ruttmann and Marion Dietl and Feuchtner, {Gudrun M.} and Bernhard Metzler and Nikolaos Bonaros and Taggart, {David P.} and Mario Gaudino and Hanno Ulmer and Umberto Benedetto and Brian Buxton and {Di Franco}, Antonio and Stephen Fremes and Girardi, {Leonard N.} and Steven Goldman and Robert Habib and Holman, {William L.} and Puskas, {John D.} and Elfriede Ruttmann-Ulmer and Schwann, {Thomas A.} and James Tatoulis and Robert Tranbaugh and Giuseppe Speciale and Giuseppe Nasso and Neil Moat and Philip Hayward and Hare, {David L.} and Jialin Mao and Miodrag Peric and Ivana Petrovic and Yoo, {Kyung Jong}",
year = "2019",
month = "8",
doi = "10.1016/j.jtcvs.2018.10.135",
language = "English (US)",
volume = "158",
pages = "442--450",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
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number = "2",

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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

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

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