Mario Gaudino1, Umberto Benedetto2, Stephen Fremes3, Karla Ballman4, Giuseppe Biondi-Zoccai5,6, Art Sedrakyan4, Giuseppe Nasso7, Jai Raman8,9, Brian Buxton9, Philip A Hayward9, Neil Moat10, Peter Collins10, Carolyn Webb10, Miodrag Peric11, Ivana Petrovic11, Kyung J Yoo12, Irbaz Hameed1, Antonino Di Franco1, Marco Moscarelli7, Giuseppe Speziale7, John D Puskas13, Leonard N Girardi1, David L Hare14,15, David P Taggart16. 1. Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York. 2. Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom. 3. Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. 4. Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York. 5. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy. 6. Mediterranea Cardiocentro, Naples, Italy. 7. Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy. 8. Austin Hospital, Melbourne, Victoria, Australia. 9. Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia. 10. NHLI, Imperial College London, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom. 11. Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia. 12. Yonsei University College of Medicine, Seoul, South Korea. 13. Department of Cardiovascular Surgery, Mount Sinai St. Luke's, New York, New York. 14. Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia. 15. Department of Cardiology, Austin Health, Melbourne, Victoria, Australia. 16. Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.
Abstract
Importance: Observational studies have suggested that the use of radial artery grafts for coronary artery bypass grafting may improve clinical outcomes compared with the use of saphenous vein grafts, but this has not been confirmed in randomized trials. Objective: To compare clinical outcomes between patients receiving radial artery vs saphenous vein grafts for coronary artery bypass grafting after long-term follow-up. Design, Setting, and Participants: Patient-level pooled analysis comparing radial artery vs saphenous vein graft in adult patients undergoing isolated coronary artery bypass grafting from 5 countries (Australia, Italy, Serbia, South Korea, and the United Kingdom), with enrollment from 1997 to 2009 and follow-up completed in 2019. Interventions: Patients were randomized to undergo either radial artery (n = 534) or saphenous vein (n = 502) grafts for coronary artery bypass grafting. Main Outcomes and Measures: The primary outcome was a composite of death, myocardial infarction, or repeat revascularization and the secondary outcome was a composite of death or myocardial infarction. Results: A total of 1036 patients were randomized (mean age, 66.6 years in the radial artery group vs 67.1 years in the saphenous vein group; 376 [70.4%] men in the radial artery group vs 351 [69.9%] in the saphenous vein group); 942 (90.9%) of the originally randomized patients completed 10 years of follow-up (510 in the radial artery group). At a median (interquartile range) follow-up of 10 (10-11) years, the use of the radial artery, compared with the saphenous vein, in coronary artery bypass grafting was associated with a statistically significant reduction in the incidence of the composite outcome of death, myocardial infarction, or repeat revascularization (220 vs 237 total events; 41 vs 47 events per 1000 patient-years; hazard ratio, 0.73 [95% CI, 0.61-0.88]; P < .001) and of the composite of death or myocardial infarction (188 vs 193 total events; 35 vs 38 events per 1000 patient-years; hazard ratio, 0.77 [95% CI, 0.63-0.94]; P = .01). Conclusions and Relevance: In this individual participant data meta-analysis with a median follow-up of 10 years, among patients undergoing coronary artery bypass grafting, the use of the radial artery compared with the saphenous vein was associated with a lower risk of a composite of cardiovascular outcomes.
Importance: Observational studies have suggested that the use of radial artery grafts for coronary artery bypass grafting may improve clinical outcomes compared with the use of saphenous vein grafts, but this has not been confirmed in randomized trials. Objective: To compare clinical outcomes between patients receiving radial artery vs saphenous vein grafts for coronary artery bypass grafting after long-term follow-up. Design, Setting, and Participants: Patient-level pooled analysis comparing radial artery vs saphenous vein graft in adult patients undergoing isolated coronary artery bypass grafting from 5 countries (Australia, Italy, Serbia, South Korea, and the United Kingdom), with enrollment from 1997 to 2009 and follow-up completed in 2019. Interventions: Patients were randomized to undergo either radial artery (n = 534) or saphenous vein (n = 502) grafts for coronary artery bypass grafting. Main Outcomes and Measures: The primary outcome was a composite of death, myocardial infarction, or repeat revascularization and the secondary outcome was a composite of death or myocardial infarction. Results: A total of 1036 patients were randomized (mean age, 66.6 years in the radial artery group vs 67.1 years in the saphenous vein group; 376 [70.4%] men in the radial artery group vs 351 [69.9%] in the saphenous vein group); 942 (90.9%) of the originally randomized patients completed 10 years of follow-up (510 in the radial artery group). At a median (interquartile range) follow-up of 10 (10-11) years, the use of the radial artery, compared with the saphenous vein, in coronary artery bypass grafting was associated with a statistically significant reduction in the incidence of the composite outcome of death, myocardial infarction, or repeat revascularization (220 vs 237 total events; 41 vs 47 events per 1000 patient-years; hazard ratio, 0.73 [95% CI, 0.61-0.88]; P < .001) and of the composite of death or myocardial infarction (188 vs 193 total events; 35 vs 38 events per 1000 patient-years; hazard ratio, 0.77 [95% CI, 0.63-0.94]; P = .01). Conclusions and Relevance: In this individual participant data meta-analysis with a median follow-up of 10 years, among patients undergoing coronary artery bypass grafting, the use of the radial artery compared with the saphenous vein was associated with a lower risk of a composite of cardiovascular outcomes.
Authors: Lesley A Stewart; Mike Clarke; Maroeska Rovers; Richard D Riley; Mark Simmonds; Gavin Stewart; Jayne F Tierney Journal: JAMA Date: 2015-04-28 Impact factor: 56.272
Authors: Mario Gaudino; Umberto Benedetto; Stephen Fremes; Karla Ballman; Giuseppe Biondi-Zoccai; Art Sedrakyan; Giuseppe Nasso; Jai Raman; Brian Buxton; Philip A Hayward; Neil Moat; Peter Collins; Carolyn Webb; Miodrag Peric; Ivana Petrovic; Kyung J Yoo; Irbaz Hameed; Antonino Di Franco; Marco Moscarelli; Giuseppe Speziale; Leonard N Girardi; David L Hare; David P Taggart Journal: Eur J Cardiothorac Surg Date: 2019-12-01 Impact factor: 4.191
Authors: Brian F Buxton; Jai S Raman; Permyos Ruengsakulrach; Ian Gordon; Alex Rosalion; Rinaldo Bellomo; Mark Horrigan; David L Hare Journal: J Thorac Cardiovasc Surg Date: 2003-06 Impact factor: 5.209
Authors: Thomas A Schwann; Robert H Habib; Amelia Wallace; David M Shahian; Sean O'Brien; Jeffery P Jacobs; John D Puskas; Paul A Kurlansky; Milo C Engoren; Robert F Tranbaugh; Mark R Bonnell Journal: Ann Thorac Surg Date: 2018-02-14 Impact factor: 4.330
Authors: Mario Gaudino; Stephen E Fremes; Marc Ruel; Antonino Di Franco; Michele Di Mauro; Joanna Chikwe; Giacomo Frati; Leonard N Girardi; David P Taggart; Giuseppe Biondi-Zoccai Journal: J Am Heart Assoc Date: 2019-10-30 Impact factor: 5.501
Authors: Mario F L Gaudino; Sigrid Sandner; Giorgia Bonalumi; Jennifer S Lawton; Stephen E Fremes Journal: Eur J Cardiothorac Surg Date: 2020-12-01 Impact factor: 4.191
Authors: N Bryce Robinson; Hillary Lia; Mohamed Rahouma; Katia Audisio; Giovanni Soletti; Michelle Demetres; Jeremy R Leonard; Stephen E Fremes; Leonard N Girardi; Mario Gaudino Journal: J Thorac Cardiovasc Surg Date: 2021-08-10 Impact factor: 5.209
Authors: Derrick Y Tam; Rodolfo V Rocha; Jiming Fang; Maral Ouzounian; Joanna Chikwe; Jennifer Lawton; Dennis T Ko; Peter C Austin; Mario Gaudino; Stephen E Fremes Journal: Heart Date: 2020-10-20 Impact factor: 5.994